Personality Disorders Flashcards
Patients with personality disorders lack _____ about their problems; their symptoms are ego-(dystonic/syntonic).
They are Axis ____ diagnoses.
insight
ego-syntonic
Axis II
What is the DSM-IV criteria for a personality disorder?
- Pattern of behavior/inner experience that deviates from the person’s culture & is manifested in 2 or more of the following ways:
- Cognition
- Affect
- Personal relations
- Impulse control
- The pattern:
- Is pervasive and inflexible in a broad range of situations
- Is stable and has an onset no later than adolescence or early adulthood
- Leads to significant stress in functioning
- Is not accounted for by another mental/medical illness or by use of a substance
Each personality disorder is present in ___% of the population.
Personality disorders are divided into ______.
1%
3 clusters
Cluster A
Schizoid, Schizotypal, Paranoid
- Patients seem eccentric, peculiar or withdrawn
- Familial association w/ psychotic disorders
Cluster B
Antisocial, Borderline, Histrionic, Narcissistic
- Patients seem emotional, dramatic or inconsistent
- Familial association with mood disorders
Cluster C
Avoidant, Dependent, Obsessive-compulsive
- Patients seem anxious or fearful
- Familial association w/ anxiety disorders
Personality disorder not otherwise specified (NOS)
Includes disorders that do not fit into clusters A, B or C (including passive-aggressive personality disorder)
What is the etiology of personality disorders?
- Biological, genetic, psychosocial factors
- Prevalence in monozygotic twins is several times higher than dizygotic twins
How are personality disorders treated?
- Difficult to treat
- Few patients aware they need help
- Disorders tend to be chronic, life-long
- Pharmacologic treatment limited usefulness except treating coexisting symptoms of depresison, anxiety, etc.
- Psychotherapy & group therapy most helpful
What is the pneumonic for personality disorder clusters?
- Cluster A: mad
- Cluster B: bad
- Cluster C: sad
What is the DSM-IV criteria for Paranoid Personality Disorder (PPD)?
- General distrust of others, beginning in early adulthood & present in a variety of contexts
- At least 4 of the following:
- Suspicion (w/o evidence) that others are exploiting or deceiving him/her
- Preoccupation with doubts of loyalty or trustworthiness of acquaintances
- Reluctance to confide in others
- Interpretation of benign remarks as threatening or demeaning
- Persistence of grudges
- Perception of attacks on his/her character that are not apparent to others; quick to counterattack
- Recurrence of suspicions regarding fidelity of spouse or lover
Paranoid Personality Disorder
- Prevalence: ___%
- Men vs Women
- Familial incidence
- Prevalence: 0.5 - 2.5%
- Men >> women
- Higher incidence in family members of schizophrenics
What is included in the differential diagnosis of PPD?
Paranoid schizophrenia
- Unlike patients w/ schizophrenia, patients with PPD do not have any fixed delusions and are not frankly psychotic
- May have transient psychosis under stressful situations
What is the course & prognosis of patients w/ PPD?
- Some patients may eventually be diagnosed w/ schizophrenia
- Chronic course
- Lifelong marital & job-related problems
How is PPD treated?
Psychotherapy
Antianxiety medications
Short course of antipsychotics (transient psychosis)
What is the DSM-IV criteria for Schizoid Personality Disorder?
- A pattern of voluntary social withdrawal & restricted range of emotional expression, beginning in early adulthood & present in a variety of contexts.
- 4 or more of the following must be present:
- Neither enjoying nor desiring close relationships (including family)
- Generally choosing solitary activities
- Little (if any) interest in sexual activity w/ another person
- Taking pleasure in few activities (if any)
- Few close friends or confidants (if any)
- Indifference to praise or criticism
- Emotional coldness, detachment or flattened affect
Schizoid Personality Disorder
- Prevalence: ___%
- Men vs. Women
- Familial incidence
- Prevalence: 7%
- Men 2x more than women
- No increased incidence in families w/ hx of schizophrenia
What is the differential diagnosis for Schizoid Personality Disorder?
-
Paranoid schizophrenia
- Unlike pts w/ schizophrenia, patients w/ SPD do not have any fixed delusions, although these may exist transiently in some pts
-
Schizotypal personality disorder
- Pts w/ SPD do not have the same eccentric behavior or magical thinking seen in pts w/ schizotypal personality disorder
What is the course and treatment for Schizoid Personality Disorder?
- Chronic course, not always lifelong
- Treatment similar to paranoid personality disorder
- Psychotherapy; group therapy
- Low-dose antipsychotics (short course) if transiently psychotic
- Anti-depressants if comorbid major depression is diagnosed
What is the DSM-IV criteria for Schizotypal Personality Disorder?
- Pattern of social deficits marked by eccentric behavior, cognitive or perceptual distortions & discomfort w/ close relationships, beginning by early adulthood & present in a variety of contexts. 5 or more of the following must be present:
- Ideas of reference (excluding delusions of reference)
- Odd beliefs or maginal thinking, inconsistent w/ cultural norms
- Unusual perceptual experiences (bodily illusions)
- Suspiciousness
- Inappropriate or restricted affect
- Odd of eccentric appearance or behavior
- Few close friends or confidants
- Odd thinking or speech (vague, stereotyped, etc)
- Excessive social anxiety
What types of magical thinking & odd behaviors are characteristic of Schizotypal Personality Disorder?
-
Magical thinking
- Belief in clairvoyance or telepathy
- Bizarre fantasies or preoccupations
- Belief in superstitions
-
Odd behaviors
- Involvement in cults or strange religious practices
Schizotypal Personality Disorder
- Prevalence: ___%
- Familial incidence
- Prevalence: 3.0%
- Monozygotic >>> dizygotic twins
What is the differential diagnosis for Schizotypal Personality Disorder?
-
Paranoid schizophrenia
- Unlike pts w/ schizophrenia, pts w/ schizotypal personality disorder are not frankly psychotic (but can become transiently under stress)
-
Schizoid personality disorder
- Do not have the same eccentric behavior seen in pts w/ schizotypal personality disorder
What is the course and treatment for Schizotypal Personality Disorder?
- Chronic, pts may develop schizophrenia
- Psychotherapy is treatment of choice
- Short course of low-dose antipsychotics if necessary (transient psychosis)
What is the DSM-IV criteria for Antisocial Personality Disorder?
- Pattern of disregard for others & violation of the rights of others since age 15.
- Patients must be at least 18 years old
- Hx of behavior as child/adolescent must be consistent w/ conduct disorder
- 3 or more of the following should be present:
- Failure to conform to social norms by committing unlawful acts
- Deceitfulness/repeated lying/manipulating others for personal gain
- Impulsivity/failure to plan ahead
- Irritability & aggressiveness/repeated fights or assaults
- Recklessness & disregard for safety of self or others
- Irresponsibility/failure to sustain work or honor financial obligations
- Lack of remorse for actions
Antisocial Personality Disorder
- Prevalence: ___%
- What SES has higher incidence?
- Genetic component
- Prevalence
- Men 3%, Women 1%
- Poor urban areas & prisoners
- 5x increased risk among 1st degree relatives
What is the differential diagnosis of Antisocial Personality Disorder?
Drug abuse
- Necessary to ascertain which came first
- Pts who began abusing drugs before their antisocial behavior may have behavior attributable to the effects of their addiction
What is the course & treatment of Antisocial Personality Disorder?
- Chronic course
- Some improvement of symptoms as the pt ages
- Many pts have somatic complaints
- Co-existence of substance abuse and/or major depression is common
- Treatment
- Psychotherapy
- Pharmacotherapy for anxiety/depression (caution: highly addictive)
What is the acronym for Borderline Personality Disorder?
IMPULSIVE
- Impulsive
- Moody
- Paranoid under stress
- Unstable self image
- Labile, intense relationships
- Suicidal
- Inappropriate anger
- Vulnerable to abandonment
- Emptiness
What is the DSM-IV criteria for Borderline Personality Disorder?
- Pervasive pattern of impulsivity & unstable relationships, affects, self-image, and behaviors, present by early adulthood & in a variety of contexts
- At least 5 of the following must be present:
- Desperate efforts to avoid real or imagined abandonment
- Unstable, intense interpersonal relationships
- Unstable self-image
- Impulsivity in at least 2 potentially harmful ways (spending, sexual activity, substance use, etc.)
- Recurrent suicidal threats or attempts or self-mutilation
- Unstable mood/affect
- General feeling of emptiness
- Difficulty controlling anger
- Transient, stress-related paranoid ideation or dissociative symptoms
Borderline Personality Disorder
- Prevalence: ___%
- Women vs. Men
- Suicide rate: ___%
- Prevalence: 1-2%
- Women 2x more than men
- Suicide rate: 10%
What is the differential diagnosis for Borderline Personality Disorder?
Schizophrenia
- Unlike pts with schizophrenia, pts w/ borderline personality disorder do not have frank psychosis
- May have transient psychosis, however, if decompensate under stress
What is the course of Borderline Personality Disorder?
- Stable, chronic course
- High incidence of coexisting major depression and/or substance abuse
- Increased risk of suicide
- Patients will make suicide gestures and kill themselves by accident
How is Borderline Personality Disorder treated?
-
Psychotherapy is the treatment of choice
- Behavior therapy
- Cognitive therapy
- Social skills training
-
Pharmacotherapy
- Psychotic or depressive symptoms
What is the DSM-IV criteria for Histrionic Personality Disorder?
- Pattern of excessive emotionality & attention seeking, present by early adulthood and in a variety of contexts
- At least 5 of the following must be present:
- Uncomfortable when not the center of attention
- Inappropriately seductive or provocative behavior
- Uses physical appearance to draw attention to self
- Has speech that is impressionistic and lacking in detail
- Theatrical & exaggerated expression of emotion
- Easily influenced by others or situation
- Perceives relationships as more intimate than they actually are
Pharmacotherapy has been shown to be more useful in __________ disorder than in any other personality disorder.
Borderline personality disorder
Histrionic Personality Disorder
- Prevalence: ___%
- Women vs. Men
- Prevalence: 2-3%
- Women >> Men
What is the differential diagnosis for Histrionic Personality Disorder?
Borderline Personality Disorder
- Patients w/ BPD are more likely to suffer from depression & to attempt suicide
- HPD pts are generally more functional
What is the course & treatment for Histrionic Personality Disorder?
- Chronic course, some improvement of symptoms with age
- Psychotherapy is the treatment of choice
- Pharmacotherapy to treat associated depressive or anxious symptoms
Histrionic patients often use the defense mechanism of ______.
Regression (revert to childlike behaviors)
What is the DSM-IV criteria for Narcissistic Personality Disorder (NPD)?
- Pattern of grandiosity, need for admiration, & lack of empathy beginning by early adulthood and present in a variety of contexts.
- 5 or more of the following must be present:
- Exaggerated sense of self-importance
- Preoccupied w/ fantasies of unlimited money, success, brilliance, etc.
- Believes that he/she is “special” or unique and can associate only with other high-status individuals
- Needs excessive admiration
- Has sense of entitlement
- Takes advantage of others for self-gain
- Lacks empathy
- Envious of others or believes others are envious of him/her
- Arrogant or haughty
What is the prevalence of Narcissistic Personality Disorder?
<1%
What is the differential diagnosis for Narcissistic Personality Disorder?
Antisocial personality disorder
- Both types of pts exploit others
- But, NPD pts want status & recognition, while antisocial pts want material gain or simply the subjugation of others
- Narcissistic pts become depressed when they don’t get the recognition they think they deserve
What is the course & treatment for Narcissistic Personality Disorder?
- Chronic course
- Higher incidence of depression & midlife crisis
- High value on youth & power
- Psychotherapy is treatment of choice
- Antidepressants or lithium if needed
- For mood swings if comorbid mood disorder is diagnosed
Patients with avoidant personality disorder _____ companionship but are extremely _____ and easily _____.
desire, shy, injured
What is the DSM-IV criteria for avoidant personality disorder?
A pattern of social inhibition, hypersensitivity & feelings of inadequacy since early adulthood, w/ at least 4 of the following:
- Avoids occupation that involves interpersonal contact due to a fear of criticism and rejection
- Unwilling to interact unless certain of being liked
- Cautious of intrapersonal relationships
- Preoccupied w/ being criticized or rejection in social situations
- Inhibited in new social situations b/c he/she feels inadequate
- Believes he or she is socially inept and inferior
- Reluctant to engage in new activities for fear of embarrassment
Avoidant Personality Disorder
- Prevalence: ___%
- Men vs. Women
- Prevalence: 1-10%
- Sex ratio unknown
What is the differential diagnosis for Avoidant Personality Disorder?
-
Schizoid personality disorder
- Pts w/ APD desire companionship but are extremely shy
- Pts w/ schizoid have no desire for companionship
-
Social phobia
- Fear & avoidance of social situations
- Personality disorder if integral part of personality and evident before adulthood
- Social phobia: fear of embarrassment in setting
- APD: fear of rejection & sense of inadequacy
-
Dependent personality disorder
- APD pts cling to relationships but slow to get involved; dependents more aggressive
What is the course of Avoidant Personality Disorder?
- Course usually chronic
- Difficult during adolescence, when attractiveness & socialization are important
- Increased incidence of associated anxiety & depressive disorders
How is Avoidant Personality Disorder treated?
-
Psychotherapy
- Assertiveness therapy most effective
-
Beta blockers
- Control autonomic symptoms of anxiety
-
SSRIs
- Major depression
What is the DSM-IV criteria for Dependent Personality Disorder?
A pattern of submissive & clinging behavior due to excessive need to be taken care of. At least 5 of the following must be present:
- Difficulty making everyday decisions w/o reassurance from others
- Needs others to assume responsibilities for most areas of his/her life
- Cannot express disagreement b/c of fear of loss of approval
- Difficulty initiating projects b/c of lack of self-confidence
- Goes to excessive lengths to obtain support from others
- Feels helpless when alone
- Urgently seeks another relationship when one ends
- Preoccupied w/ fears of being left to take care of self
Dependent Personality Disorder
- Prevalence: ___%
- Women vs. Men
- Prevalence: 1%
- Women >>> Men
What is the differential diagnosis for Dependent Personality Disorder?
- Avoidant personality disorder
-
Borderline & histrionic personality disorder
- DPD: long-lasting relationship w/ one person on whom they are dependent
- Borderline/Histrionic: dependent on other people but unable to maintain a long-lasting relationship
What is the course of Dependent Personality Disorder?
- Usually chronic course
- Symptoms decrease w/ age and/or therapy
- Pts prone to depression, particularly after loss of person on whom they are dependent
How is Dependent Personality Disorder treated?
- Psychotherapy is the treatment of choice
- Pharmacotherapy
- Treat associated symptoms of anxiety or depression
What is the DSM-IV criteria for Obsessive-Compulsive Personality Disorder (OCPD)?
Pattern of preoccupation w/ orderliness, control & perfectionism at the expense of efficiency, present by early adulthood & in a variety of contexts. At least 4 of the following must be present:
- Preoccupation w/ details, rules, lists and organization such that the major point of the activity is lost
- Perfectionism that is detrimental to completion of task
- Excessive devotion to work
- Excessive consientiousness & scrupulousness about morals & ethics
- Will not delegate tasks
- Unable to discard worthless objects
- Miserly
- Rigit & stubborn
Obsessive Compulsive Personality Disorder
- Prevalence: ___%
- Men vs. Women
- Family incidence
- Prevalence unknown
- Men >> women
- Most often in the oldest child
- Increased incidence in 1st degree relatives
What is the differential diagnosis for OCPD?
-
OCD
- Pts w/ OCPD don’t have recurrent obsessions or compulsions in OCD
- Symptoms of OCPD are ego-syntonic rather than ego-dystonic
-
Narcissistic personality disorder
- Both personalities involve assertiveness & achievement
- NPD pts motivated by status, OCD pts motivated by the work itself
What is the course for pts with OCPD?
- Unpredictable course
- Some pts later develop obsessions or compulsions (OCD), some develop schizophrenia or MDD, others may improve or remain stable
How is OCPD treated?
- Psychotherapy is treatment of choice
- Group therapy & behavior therapy may be useful
- Pharmacotherapy may be used to treat associated symptoms as necessary
What does Personality Disorder Not Otherwise Specified (NOS) include?
- Passive-aggressive personality disorder
- Depressive personality disorder
- Sadomasochistic personality disorder
- Sadistic personality disorder
Describe pts with Passive-Aggressive Personality Disorder
How is it treated?
- Stubborn, inefficient procrastinators
- Alternate btwn compliance & defiance
- Passively resist fulfillment of tasks
- Frequently make excuses for themselves & lack assertiveness
- Attempt to manipulate others to do their chores, errands, etc.
- Frequently complain about their own misfortunes
- Treatment: psychotherapy
