Personality Disorders Flashcards
A General Personality Disorder requires 2 of the following; __________ and _________
perceptions, affect, interpersonal, functioning, impulse control; occurs across a range of personal social situations, leads to clinically significant distress or impariment
Type A personality disorder includes:
paranoid personality disorder: what most normal people see as being “odd” Person is extremely paranoid, distrustful, harm them, thinks people are out to get them, relunctant to share information with them, act as if they’re under attack
schizoid personality disorder:
people who are really flat, and don’t usually seek help because they don’t want it, prefer to be alone, NOT UPSET IF YOURE CRITICAL OF THEM
schizotypal personlity:
most like schizophrenia, not exactly hallucinatinos, ideas of referes (incorrect interpertations of events that they say are just for them)
cIuster B personality disorder is characterized by:
dramatic emotional or erratic behavior
one type of cluster B disorder is antisocial personality disorder and it is characterized by:
failure to conform to social norms, laws, deceitfulness, impusivity (don’t care about laws, etc, only care about themselves and they’re)
if someone beats their significant other and then says “its your fault for making me angry”
antisocial personality disorder cluster B
borderline personality disorder has 4 main characteristics
unstable relationships, trouble regulating their emotions, poor self image, very impulsive (FEAR OF ABANDONMENT)
an impulsive suicide attempt is common for people with:
borderline personality disorder
histrionic personality disorder is a type ____ and is characterised by:
type B, attention seeking, maybe likeable, anything to get attention, make more out of friendship than they really should be
Narcissistic personality disorder is a _____ and is characterised by:
type B, grandiose sense of self-importance, preoccupied with unlimited success, power, brilliance, want people to kiss their feet, think so much of themselves and so little of everyone else
cluster C are:
anxious or fearful
avoidant personality disorder is:
avoid situations involving interpersonal interactions for fear of criticism, or rejection, feels inadequate, views self as inept, unappealing, or inferior
both avoidant personality disorder and narcisistic personality disorder both have _____, but:
narcisistic people take that low self esteem and direct it out towards others while avoidant personality disorder patients direct those feelings towards themselves (call themselves stupid, asshole, etc)
dependent personality disorder:
diff bc these people can only survive when they’re in a relationship with someone else who says it’s ok, what they’re doing is ok, and if they get out of one, they’re right bac in another, and they’ll stick in a relationship with an abusive person
obsessive-compulsive personality disorder:
not impulsive! Total opposite, super rigid, not flexible, need to be in control, workaholic, may obsess about details to the point they miss the big picture
56 yo man presents to psychiatrist bc pcp concern of restricted affect and depression, who reports no complaints but gives a history of isolation and very limited interactions with others. The results of the patien’ts mental status examination are essentially normal, other than showing a restricted emotional range:
schizoid personality disorder
48 yo woman presents to psychotherapist. She lives a very secluded life as a night time janitor at a department store and takes care of her elderly mother. She complains of feeling longely and is aware that she has a great deal of difficulty relating to othe people. What distinguishes her condition from someone with schizoid personality disorder?
A family history of a cousin with schizophrenia
a desire to engage in interpersonal relationships
lack of hallucinations or delusional thinking
her gender
a history of alcoholism
a desire to engage in interpersonal relationships
hallmark of schizoid personality disorder is detachment and disinterest in social relationships. This patient is clearly distressed by her lack of social relationships, which would clearly steer the diagnosis away from schizoid personality disorder. Men are more frequently, though not exclusively diagnosed with schizoid personality disorder
a patient with schizoid pd comes to pcp with complaint of polyuria and polydipsia. He is found to have insulin-dependent diabetes. Which of the following interventions is likely to be most well received by the patient?
asking the patient to bring in a relative or close friend so that he can describe the treatment regimen to both of them at the same time
Referring the patient to a therapist for support in dealing with a chronic illness
Giving the patient detailed written information about the disease and telling him that the physician will be available to answer any questions
Referring the patient to a group that helps its members learn about diabetes
Scheduling frequent appointments with the patient so that all the treatment details cann be explained on a one-to-one basis
Giving the patient detailed written information about the disease and telling him that the physician will be available to answer any questions
They generally prefer to keep social interaction to a minimum .They do better with a more technical approach with as little human interaction as possible
a woman with schizoid personality disorder was in a care accident and was rear-ended. The driver of the other car refused to take responsibility and hired a lawyer to provide his defense. The woman spends hours every day thinking about the specifics of the accident, including the colors of the cars involved, and what each party to the accident was wearing. Which of the following defense mechanisms is she using? sublimation undoing projecting intellectualization introjection
intellectualization
this is characterized by rehashing events over and over
a 20 yo man is brough to psychiatrist by his parents for odd thinking. He is dressed in clothes more consistent with a 1960's hippie, with long hair and marginal hygiene. He was reently fired for not showing up for his shifts and was forced to move back with parents. He has artistic aspirations and is very interested in philosophy, metaphysics, magic and occult. He talks about his desire for fame and wealth, given his special talents. He has recently gotten into some legal trouble as he prduced art work of fanciful paper currency, which he attempted to use at some local stores. Hower, he admits that he did not think that this was going to work and describes this as a performance art. Which of the following is most likely the diagnosis? schizophrenia schizoid personality disorder schizotypal personality disorder delusional disorder bipolar disorder
schizotypal personality disorder
32 yo incarcerated man is seen by a psychiatrist after he gets into a fight with an inmate. He has a long history of incarceration and inability to conform to societal norms, which seems to have begun around age 13. He does not seem to be remorseful about his actions.
antisocial personality disorder
39 yo is evaluated in prison, and has a history of multiple arrests as both and adult and juvenile. After several interviews, he is diagnosed with antisocial personality disorder. He has a history of multiple psychiatric hospitalizations after suicide attempts and was in special ed programming as a child. What diagnosis is likely to have occurred comorbidly? ADHD Cocaine dependence TBI Major Depression Conduct Disorder
Conduct Disorder
even though the others are frequently comorbid, evidene of a diagnosis of conduct disorder before age 15 i REQUIRED for a diagnosis of antisocial personality disorder.
16 yo is incarcerated in a juv facility and is charged with theft, apparently to support her and her bf drug habit. She has had multiple invovlements with child and family services for running away from home, where she was sexually abused by her mother’s bf. She has a diagnosis of ptsd. Prior to the onset of the abuse, she was doing extremely well in school, in an accelerated program. Which of the following speaks most strongly against a diagnosis of antisocial disorder?
her concurrent diagnosis of ptsd
her gender
her age
antisocial acts committed to support her drug habit
apparent high intelligence
AGE!
antisocial disorders cannot be diagnosed before 18 yr old. Antisocial personality disorder should not be overlooked in females, even though it is much more common in males. Antisocial actions committed solely during psychotic or manic episodes or to support a drug habit would not support a diagnosis of antisocial personality disorder
A 39 yo man with antisocial personality disorder incarcerated for life after murdering a man has a multitude of somatic complaints over the course of several years. Yearly physical exams never show anything physically wrong with him, yet he complains of a variety of aches and pains, neurologic symptoms, and GI distress. He does not enjoy the time he spends in the jail's infirmary. Which of the following is the most likely explanation for the complaints? He is malingering he has developed a psychotic disorder he has developed a somatic disorder he has an undiagnosed physical illness he has an undiagnosed anxiety disorder
he has developed a somatic disorder
development of a somatic a mental disorder (characterized by recurring, multiple, and current, clinically significant complaints about somatic symptoms, although it is no longer considered a clinical diagnosis) is more common in patients with antisocial personality disorder as they grow older. There is no evidence of secondary gain here (which rules out malingering) nor is there evidence of psychotic thinking. Physical examinations have all been negative so physical illness is out, and the complaints are all around somatic symptoms, making a pure anxiety disorder unlikely
which of the following is most consistent with antisocial personality traits?
13 yo living in an economically depressed area joins a gang to avoid being beaten up by competing gangs
38 yr old drug addict who has been arrested seven times for retail theft
67 yr old CEO who embezzles from his company, is unfaithful to his third wife, and has been involved in covering up corporate malfeasance from federal investigators
a 42 yo homeless female shizophrenic who has been arrested on misdemeanor trespassing charges 5 times in 2 years
a 28 yo woman who has a history of prostitution, drug abuse, and multiple suicide attempts with over 20 inpatient psychiatric admissions
67 yr old CEO who embezzles from his company, is unfaithful to his third wife, and has been involved in covering up corporate malfeasance from federal investigators
note, A is too young to be diagnosed with any personality disorder!
D is resorting to antisocial acts in order to survive
B the individual is stealing to support his drug habit
E is borderline personality disorder
C is displaying patterns of violating the rights of others across several settings
21 yo comes to counselor after an embarassing interpersonal interaction in class. She has a long history of avoiding close interpersonal relationships bc of a fear of being rejected. She avoids new interpersonal situations bc she feels inadequate
avoidant personality disorder
treatment:
psychodynamic or CBT
a patient is so nervous at work that he cannot think straight. He reports that his mood at home has been good, but that he knows he will fail at the new job bc, “I have always been such a dope when it comes to working with other people.” After several sessions, the counselor diagnoses the patient with avoidant personality disorder. Which of the following would be the most helpful in assisting the patient to manage his anxiety regarding his new job?
tel the patient that he needs to be more confident and to “suck it up”
engage the ptient in cognitive therapy to help him deal with his distorted thinking
prescribe a benzo
tell the patient that he is probably not ready for this job if he is this anxious
engage the ptient in cognitive therapy to help him deal with his distorted thinking
goal is to help patients critically examine if their assumptions about themselves and other people are correct
24 yo present to therapist. Which of the following is consistent with avoidant personality disorder?
i have a couple close friend but it is very hard to make friends. I m afraid most people wouldn’t want me around
I’m usually fine around people. It’s just when Im’ around a lot of people I’ve never met before that I freak out
Im afraid that people are plotting against me
My mom thinks I have a problem with people. I can take them or leave them
My gf thinks I have a problem with people, like with her friends, what do you think?
i have a couple close friend but it is very hard to make friends. I m afraid most people wouldn’t want me around
patient has some close relationships and seems to desire more but thinks people won’t want him around
B is a social phobia
C is paranoid (psychotic disorder)
D is schizoid
E suggests dependent personality disorder
characterize the difference between patients with avoidant personality disorder and those with schizoid personality disorder
patients with avoidant would like to have friends more than patients with schizoid personality disorder
35 yo woman is engaged in psychotherapy for avoidant personality disorder. SHe is distressed by her inability to maintain a romantic relationship with a man. During the course of treatment, the therapist learns that her father was an alcoholic and was physically abusive to the patient and her mother. Which defense mechanism is the patient using? undoing splitting isolation of affect idealization displacement
This patient can be theorized to be using displacement to assume all men will act as punitively toward her as her father did. Displacement and pojection are the two defense mechanisms most commonly utilized by patients with avoidant personality disorders. Undoing is a defense mechnism in which a person tries to “undo” an unhealthy thought or action by engaging in its opposite. Spiltting is often used by patients with a personality disorder in which a person literally spilts apart the positive and negative qualities of the self and others. For example, an individual is either all bad or all good but never an integrated whole of both good and bad. Isolation of affect is a defense mechanism involving the creation of a gap between an unpleasant or threatiening cognition, and other thoruhgts and feelings. Idealization is the defense mechanism in which a person attributes exaggeratedly possitive qualities to the self and others
36 yo old has lifetime preoccupation with rules, work, order, and stinginess. Has trouble at work bc he keeps missing deadlines and has difficulty making decisions Patient does not realize he is the cause of the problems and blames others. Has a rigid and stubborn manner
OCD
24 yo is called into head office and told her chronic lateness in completing assignments will result in her dismissal if she does not change. The patient really loves her job, and the news comes as a major blow. She tells her bf in great detail about each and every step of the meeting and spends the entire night thinking about her job. The bf tells her she does not "look" particulatly upset. which defense mechanism is this? undoing displacement intellectualization rationalization splitting
intellectualization
23 yo med student makes lists of all the tasks that he must accomplish each day. He spends hours studing and refuses to go out with his colleagues even when there are no tests on the immediate horizon, preferring to spend his time looking at specimens in lab. He keeps meticulous notes during all his classes and prefers to attend every lecture, not trusting his colleagues to take notes for him. He is doing well in school and has a gf who is also a medical student: ocd oc personality disorder obsessive-compulssive traits schizoid personality disorder paranoid personality disorder
obsessive compulsive traits bc his social and occupational functioning both are good, so that rules out personality disorder
26 yo woman has been taking 6-7 hour long showers every day. She explains, "it all starts when I wake up, I am sure I am covered in germs and if I don't wash, I will get sick. If I don't wash, I get paralyzed with anxiety. Once I'm in the shower, I have no shower in a particular order. If I mess up, I have to start over, and this takes hours and hours. My skin is cracking and bleeding becaue I spend so much time in the water." Which of the following conditions does this patient is most likely have? ocd oc personality disorder obsessive-compulssive traits schizoid personality disorder paranoid personality disorder
OCD: patient demonstrates classic obsessions and compulsions
a patient with ocpd may also be categorized in a grouping of disorders named cluster C personality disorders. Which other personality disorders is part of Cluster C antisocial schizotypal narcissistic avoidant borderline
avoidant
42 yo man comes with complaint of depressed mood and difficulty sleeping. He says his gf recently left him, and although he is upset about the loss, he cannot describe her in any specific detail, and they had not been going out together for very long. The patient’s speech and manner appear somewhat theatrical and overblown. His affect appears euthymic and full range, and he appears to be trying to directly engage the female interviewer by touching her and asking her direct personal questions. In this manner, he appears to be trying to draw attention to himself by being somewhat seductive. He is shown to have normal thought processes and thought content on a mental status examination:
histrionic personality disorder
35 yo woman with histrionic personality disorder has seen her psychotherapist once a week for the past year. She has come in the last few visits subtly different. She appears more distracted, she is late for appointments, she reports an increased amount of arguments with her famiy, and she appears flushed and even sweaty. You asked aabout use of illicit substances and she denies it. An important next step might be which of the following?
calling a family member about this change?
request a urine toxicology to screen for substances
no further workup is necessary, continue with the current framework of psychotherapy and treatment
ask her to go to her primary care physician
refer her to an alcoholics anonymous group
request a urine toxicology to screen for substances
substance use is a common feature of cluster B personality disorders. Significant changes in unusual behavior, alienation from loved ones, and physical signs are common features. Often patients are reluctant to admit use so a urine toxicology might be the most important step to help plan an appropriate intervention.
a 23 yo woman with histrionic personality disorder comes to see her physician for frequent headaches. As the (male) physician is taking the patient’s history, he notices that the patient is frequently reaching across the desk to touch his arm as he talks to her, as well as leaning far forward in her seat to be nearer to him. Which of the following responses is most appropriate?
tell the patient to stop touching him immediately
move his seat further from the patient so she cannot reach him
tell the patient that she will be referred to a female physician
tell the patient that he understand her concern about her headaches but touching him is not appropriate
tell the patient he understands her gratitude in this situation
tell the patient that he understand her concern about her headaches but touching him is not appropriate
this is best managed by being tactful and sympathetic to the patient, but firmly and clearly placing boundries on such behavior
a 20 yr old woman comes to see a psychiatrist at the insistance of her mother who says her daughter "isn't herself." The patient is spending a great deal more time alone in her bedroom, she doesn't seem to care for her hygiene as well, and has been missing work a great deal more .She is very clingy and attention seeking with her mother: histrionic borderline bipolar mdd delusional
mdd:
she has a new onset of behavior unlike her usual personality which is common in mdd
which of the following personality traits is most likely seen in patients with histrionic pd callousness emotional lability recklessness cognitive dysregulation grandiosity
histrionic pd usually demonstrate emotional lability (emotional lability is a sign or symptom typified by exaggerated changes in mood or affect in quick succession)
grandiosity is seen in antisocial and narcissistic
cognitive dysregulation is seen in borderline and schizotypal
recklessness in antisocial and borderline
callousness in antisocial personality
32 yo has been depressed since broke up with gf 2 weeks ago. Has no vegatative signs or symptoms of mdd. Overly reliant on his mother for major decisions and still lives at home. He has difficulty expressing disagreement with his mom bc he is afraid she will not support him. The patient does well at his job but has turned down any position that would require him to take responsibility for others. He seems to be very dependent on a few close friends as well:
Dependent personality disorder
30 yo is referred from pcp. He lives with mom and relies on her to make every day decisions. Has never worked and depends on her for financial support. Lacks self-confidence and is uncomfortable when left alone. Since his mother's diagnosis of cancer, the patient is preoccupied with the fear of his mother dying and being left aloe to care for himself. avoidant borderline dependent histrionic ocpd
dependent
avoidant: fear of humiliation
borderline: unstable and intense relationships
dependent: submissive reactive and clingy
histrionic: flamboyance with demanding personality
ocpd: pattern of preoccupation with order, perfection, and control
30 yo is referred from pcp. He lives with mom and relies on her to make every day decisions. Has never worked and depends on her for financial support. Lacks self-confidence and is uncomfortable when left alone. Since his mother’s diagnosis of cancer, the patient is preoccupied with the fear of his mother dying and being left aloe to care for himself.
what is the best/most useful treatment? antianxiety meds antidepressant meds nothing bc research suggests he'll get better over time individual psychotherapy sociotherapies
sociotherapies
sociotherapies (group, family, milieu) have demonstrated to be moderately effective for patients who face the loss of their usual support systems. Medications for depression, anxiety, and or psychosis would be indicated if the patient had a comorbid psychiatric illness which is not evident (while it’s true some personality disorders get better, some get worse, so treat!)
45 yo married woman was admitted to the surgical service 2 days ago for appendectomy. The procedure went well, but she was found tearful saying “I wish I were dead.” On obtaining further history, she is quite cooperative and talkative. She is questioned about the earlier comments, and she states the she “wanted attention.” She was upset that her husband was not with her. She says she has never been away from him for that long since they started dating when the patient was 16 yo. She feels helpless and is having a diff time being active in her care. She feels overwhelmed regarding her postsurgical and discharge instruction, adn the nursing staff has become frustrated with her constant need for reassurance. Althought at times she is tearful during the interview, she denies prior or recent pervasive depressive or neurovegetative symptoms and is not actively suicidal:
encourage her to learn more about her surgery and become proactive in her care?
persuade her to become less dependent on her husband
insist her hhusband be present at all times while his wife is hopitalized
spend regular, short periods of time with her to discussdischarge planning and aftercare
transfer her to the psychiatric unit
spend regular, short periods of time with her to discussdischarge planning and aftercare
the patient discplays dependent personality disorder, and the most effective approach to dealing with her is to respect her need for attachment and schedule limited but regular appointments with her. Individuals with
a 24 yo immediately potpartum woman is referred by obstetrics service bc a staff member believes she might be schizophrenic. The patient has odd beliefs and thinking, ideas of reference, and a constricted affect. She also dresses in a peculiar maner. She does not hve close friends. Her thinking is tangential, but her thought content is within normal limits:
schizotypal personality disorder
which of the following features must be present in a patients history to diagnose schizotypal auditory hallucinations cognitive and perceptual distortions impulsive or manipulative behaviors paranoid ideations unstable and intesne relationships
cognitive and perceptual distortions
the odd quality with which patients perceive and think about the world is one of the diagnositc criteria
C and E are characteristics of boerderline personality disorder
a 25 yo with schizotypal comes to his psychiatrist with a complaint of a depressed mood. He notes that since losing hsi job as an astrologer, he has been depressed and unable to sleep. He says althrough his mood is usually fairly low (4 out of 10), it has lately been a constant 2. The patient also notes problems with concentration and energy level, and has crying spells. He reports he had premonitions that certain foods could heal him, so he has been mixing "magical potions" and eating "magical foods," A mental status exam reveals an ddly dressed man with constricted affect, ideas of reference, unusual believes and some mild paranoia. Which medication should he get? zopidem (ambien for insomnia) divalproex sodium for mood disturbance escitalopram for depression risperidone for paranoia ziprasidone for ideas of reference
escitalopram
it is a ssri useful in treating depression. Patients with schizotypal pd who have either a depressive component to their illness or a secondary superimposed major depression (as in this case) should be treated with antidepressants. Ziprasidone and risperidone are atypical antipsychotics that would be effective if the patient was having transient psychotic episodes, and divalproex sodium would be good for treating mania
45 yo man is admitted after a heart attack. 24 hours later he tries to leave the hospial against medical advice bc he is angry about the way the staff treated him. He as a grandiose sens of selfimportance and feels entitled. He is interpersonally exploitative with the psychiatrist who interviews him and is obviously envioius of a watch that he thinks is expensive. He shows no other abnormalities:
Narcissistic pd
22 yo single grduate student with narcissistic pd is admitted to a hospital after a car accidnet in which his right femur is fractured. A medical studetn has been assigned to follow the patient, but when she enters the room and introduces herself as a medical student, the patient states “oh, I wouldn’t let a medical student touch me-I need someone with much more experience than you.” Which of the following statements by the medical student is most likely to lead to a successful interview?
I know this will be boring for you, but it’s just one of the things you will have to put up with in the hospital
I know you must be scared to be in the hospital, but you will be safe here
I’m told that you are a avery articulate person, and I ‘m hoping you’ll teach me what I need to know
I understand that you think you deserve only the best, but I have been assigned to you
Please don’t make this difficult, I hve to interview you as part of my job
C
Appealing to the patient’s narissism by being admiring most often de-escalates the patient as well as improves the therapeutic alliance
22 yo single grduate student with narcissistic pd is admitted to a hospital after a car accidnet in which his right femur is fractured. A medical studetn has been assigned to follow the patient, but when she enters the room and introduces herself as a medical student, the patient states “oh, I wouldn’t let a medical student touch me-I need someone with much more experience than you.” Which of the following statements by the medical student is most likely to lead to a successful interview?
The patient wiill most likely become depressed after which of the following?
aging
graduation
job change
marriage
moving to a new city
aging
patient with NPD usually don’t handle aging well because they value beauty, strength, and youth. Any blow to their fragile (but covert) self-esteem can raise their feelings of envy and anger, and subsequently lead to depression.
36 yo man with npd calls your office asking for an appointment with "the best therapist in the clinic." Theh patient states "they are not giving e the credit I deserve for my accomplishments at the law firm." What is most likely reason the patient is seeking treamtnet? anger anxiety attempting to identify with others grandiose thinking seeking medication
anger
patients with npd rarely seek treatment and tend to have little insight into their grandiosity. When these individuald do present for treatment, it is usually due to underlying anger or depression from being belittled or not receiving the admiration to which they feel entitled.
36 yo man with npd calls your office asking for an appointment with “the best therapist in the clinic.” Theh patient states “they are not giving e the credit I deserve for my accomplishments at the law firm.”
the patient begins seeing the therapist 2x a week for the last year. During one session, the therapist comes in 4 min late and apologizes to the patient stating that he had an emergency with another patient. During the session, the patient notes that the therapist “isn’t as sharp as some of the therapists I hear on the talk shows,” which defense mechanism is this?
denial
devaluation
isolation of affect
rationalization
splitting
devaluation
