Personality Disorders

Question 1

Personality

Answer 1

Stable, enduring aspects of a person’s repsonse style; shapes their inner experiences and behaviours in response to stressors.

Question 2

Personality Disorder

Answer 2

Enduring pattern of inner experience and behaviour that…

1. Deviates markedly from the expectation of the individual’s culture
2. Is pervasive and inflexible
3. Onset in adolescents or early adult
4. Stable over time and leads to distress or impairment
5. Does not occur exclusively during the course of a disorder
6. Not attributable to a medical condition

Question 3

Epidemiology of Personality Disorders

Answer 3

6-15% of the population meets the criteria for at least one PD

Most common is OCPD (2.5%)

Question 4

Treatment of Personality Disorders

Answer 4

Psychotherapy

CBT

DBT

Question 5

Cluster A

Answer 5

“Mad / odd / weird”

Includes schizoid PD, schizotypal PD, and paranoid PD

Question 6

Schizoid PD

Answer 6

Pervasive pattern of detachment from social relationships without overt longing for others, and restricted emotional expression.

Cluster A

Enjoy time alone and have difficulty expressing anger.

Need _>_4/7 DISTANT

Detached or flattened affect

Indifferent to criticism or praise

Sexual experiences of little interest

Tasks done solitarily

Absence of close friends

Neither desires nor enjoys close relationships

Takes pleasure in few activities

Question 7

Schizotypal PD

Answer 7

Pervasive pattern of social and interpersonal deficits marked by acute discomfort in close relationships as well as multiple oddities and eccentricities.

Ideas are less firmly held than in psychosis.

Need _>_5/10 of ME PECULIAR

Magical thinking

Experiences unusual perceptions

Paranoid / suspicious ideation

Eccentric behaviour or appearance

Constructed or inappropriate affect

Unusual thinking or speech

Lacks close friends

Ideas of reference

Anxiety in social situations

Rule out psychotic disorder

Question 8

Paranoid PD

Answer 8

Pervasive distrust and suspiciousness of others motives (tend to believe that other people’s actions are malevolent)

Requires _>_4/7 of SUSPECT

Spousal infidelity suspected

Unforgiving

Suspicious

Perceives attacks and reacts quickly

Enemy or friend?

Confiding in others is feared

Threats perceived in benign events

Question 9

Cluster B

Answer 9

“bad / dramatic / wild”

Includes borderline PD, histrionic PD, narcissistic PD, and antisocial PD

Question 10

Borderline PD

Answer 10

Pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsitivity, beginning by early adulthood and present in a variety of contexts.

Need _>_5/9 of IMPULSIVE

Impulsiveness

Moodiness

Paranoia or dissociation under stress

Unstable self-image

Labile intese relationships

Suicidal gestures

Inappropriate anger

Vulnerability or abandonment

Emptiness (feelings of)

Tx: DBT

Question 11

Histrionic PD

Answer 11

A pervasive pattern of excessive emotionality and attention seeking, dramatic, emotional, attention-seeking style.

Need _>_5/8 of PRAISE ME

Provocative behaviour

Relationships considered more intimate than they are

Attention (center of)

Influenced easily

Style of speech

Emotions shallow

Make up

Emotions exagerated

Question 12

Narcissistic PD

Answer 12

Pattern of grandiosity, need for admiration, and lack of empathy.

Need _>_5/9 of GRANDIOSE

Grandiose

Requires attention

Arrogant attitudes

Need to be special

Dreams/fantasies of success and power

Interpersonally exploitative

Others’ feelings (lacks empathy)

Sense of entitlement

Envious of others

Question 13

Antisocial PD

Answer 13

Can’t be diagnosed until 18

Highest lethality of suicide means

Pervasive pattern of disregard for and violation of the rights of others.

Need _>_3/7 of CORRUPT

Cannot conform to laws

Obligations ignored

Reckless disregard for safety

Remorselessness

Underhanded (deceitful)

Planning Insufficient (impulsive)

Temper

Question 14

Cluster C

Answer 14

“sad / anxious / wimpy”

Includes Obsessive-Compulsive PD, Dependent PD, and Avoidant PD

Question 15

Obsessive-Compulsive PD

Answer 15

A persistent pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexiblility, openness, and efficiency.

Nothing to do with OCD.

Diagnosis requires _>_4/8 of SCRIMPER

Stubborn

Cannot discard worthless objects

Rule obsessed

Inflexible

Miserly spending

Perfectionistic

Excludes leisure

Reluctant to delegate to others

Question 16

Dependent PD

Answer 16

A pervasive and excessive need to be taken care of that leads to submissive and clinging behaviour and fears of separation.

Need _>_5/8 of RELIANCE

Reassurance required

Expressing disagreement difficult

Life responsibilities assumed by others

Initiating projects difficult

Alone

Nurturance

Companionship sought urgently when relationship ends

Exaggerated fears of being left to care for self

Question 17

Avoidant PD

Answer 17

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

Need _>_4/7 of CRINGES

Criticism or rejection preoccupies thoughts in social situations

Restraint in relationships due to fear of shame

Inhibited in new relationships

Needs to be sure of being liked before engaging socially

Gets around occupational activities with need for interpersonal contact

Embarassment prevents new activity

Self viewed as unappealing or inferior

Question 18

Transference and Countertransference

Answer 18

Transference is the patient’s reaction to you, based on lessons learned in previous relationships. Can be intense with PDs.

Countertransference is your reaction to the patient, including both your previous relationship-learning and the impact on patient transference.

* Recognize your own range of reactions.