Personality Disorders

Question 1

Personality disorder

Answer 1

Enduring pattern of maladaptive traits that are inflexible and pervasive across a broad range of situations and cause significant distress or impairment. Usually stable / long duration w/ onset in adolescence or early adulthood.

Question 2

Temperament vs character

Answer 2

• Temperament is genetic.

* Character is shaped by learning / environment

Question 3

General description of cluster A PDs

Which PDs are in cluster A?

Answer 3

Odd / eccentric, often detached / suspicious

Paranoid PD, Schizoid PD, and Schizotypal PD

Question 4

Paranoid PD

Answer 4

Pervasive distrust of others such that their motives are interpreted as malevolent. Not psychotically paranoid though. May hold grudges, don’t trust doctors, skeptical, often don’t have many friends. Often avoid medical treatment.

Question 5

Schizoid PD

Answer 5

Detachment from social relationships and restricted range of emotions. Loners, don’t like other people, fine w/ being alone. Unlikely to seek medical care.

Question 6

Schizotypal PD

Answer 6

Superstitious, magical-thinking, astrology, cults, scientology, ideas of reference, unusual perceptions, odd beliefs / thinking / speech / behavior, suspicious, inappropriate / constricted affect, lack of close friends, social anxiety. Relatives of people w/ schizo often have this

Question 7

General description of cluster B PDs

Which PDs are in cluster B?

Answer 7

Dramatic / emotional

Antisocial, Borderline, Histrionic, and Narcissistic

Question 8

General description of antisocial PD
Other name
Childhood behaviors

Answer 8

AKA sociopathy / psychopathy
Disregard for / violation of rights of others. Lack of empathy.
Childhood behaviors include truancy, fire-setting, cruelty to animals (often meet criteria for conduct disorder as child).

Question 9

DSM Criteria for ASPD (3 main things)

Answer 9

• A – pervasive pattern of disregard for / violation of rights of others, occurring since age 15
• B – Px is at least 18 y/o now
• C – Evidence of conduct disorder before age 15

Question 10

Co-morbidities w/ ASPD

Answer 10

Substance abuse, mood / anxiety disorders, ADHD, and pathological gambling

Question 11

General description of borderline PD

Answer 11

• Borderline b/w neurosis (anxiety, depression, irritability) and psychosis. Severe disturbance of mood / behavior. High risk of suicide. Unstable relationships, severe distortions of self-image, often impulsive / dangerous behavior such as self-harm.
• Very high proportion of pxs have had history of abuse / violence against them
• May arise in pxs w/ emotional vulnerability who were exposed to an “invalidating environment” as a kid.

Question 12

Gender ratio for borderline PD

Answer 12

3x more common in women

Question 13

DSM Criteria for borderline PD

Answer 13

Pervasive pattern of instability of relationships, self-image, and affects. Marked impulsivity, beginning in early childhood. 5+ of the following:
•Frantic efforts to avoid real or imagined abandonment
•Unstable / intense relationships alternating b/w extremes of idealization and devaluation
•Identity disturbance: unstable self-image or sense of self
•Impulsivity: spending, sex, substance abuse, reckless driving, binge eating
•Recurrent suicidal / self-mutilating behavior
•Affective instability due to unstable mood
•Chronic feelings of emptiness
•Inappropriate, intense anger
•Transient, stress-related paranoid ideation or dissociative sxs

Question 14

Co-morbidities w/ BPD

Answer 14

Mood disorders, PSTD, anxiety, eating disorders, and substance abuse.

Question 15

What percentage of BPD pxs complete suicide?

Answer 15

10%

Question 16

Histrionic PD

Answer 16

Excessive emotionality / attention seeking. Uncomfortable not being center of attention. Rapidly shifting emotions. Using physical appearance to draw attention. Being theatrical / dramatic. Easily influenced by others.

Question 17

Narcissistic PD

Answer 17

Pattern of grandiosity, need for admiration, and lack of empathy. Egotistical, inflate accomplishments, manipulate / exploit those around them to achieve their own aims

Question 18

General description of cluster C PDs

Which PDs are included in cluster C?

Answer 18

Anxious / fearful

Avoidant PD, Dependent PD, and Obsessive-compulsive PD

Question 19

Avoidant PD

Answer 19

Social inhibition, feeling of inadequacy, hypersensitivity to neg evaluation. Socially isolated due to anxiety / fear despite wanting to have friends. Lots of overlap w/ social phobia.

Question 20

Dependent PD

Answer 20

Need to be taken care of. Submissive / clinging behavior and fears of separation. Co-morbid depression / anxiety is common.

Question 21

Obsessive Compulsive PD

Answer 21

Perfectionistic, preoccupied w/ orderliness / details. Inflexible, stubborn. Different from OCD in that these pxs do not believe they have a problem (ego-syntonic). May think others around then have a problem.

Question 22

Medical conditions that may cause change in personality (8)

Answer 22

Neoplasia (frontal lobe tumor), TBI, infection (HIV, herpes encephalitis, neurosyphilis), hyperthyroidism, autoimmune disorders (CNS lupus), epilepsy (especially temporal lobe), cerebrovascular disease, and neurodegenerative disorders (AD, Huntington’s)

Question 23

Drugs for BPD

Answer 23

• Antidepressants, antispychotics, and anticonvulsants (for mood instability / impulsivity).
• Benzos are avoided due to disinhibition
• TCA’s are avoided due to risk of overdose.