Personality Disorders

Question 1

What is personality?

Answer 1

Enduring patterns of perception, cognition, and action in interpersonal world; established by end of adol and endures throughout life

• Personality = temperament (bio) + character (social and more values)
  
  • Temp - heritable, unconscious, often acquired, present in childhood, limbic/striatum
    
    • Novelty seeking, reward dependence, harm avoidance, persistence
  • Character - social, cultural, moral, matures in adulthood, conceptual and insight learning, conscious, neocortex/hippocampus
    
    • Self-directedness, cooperativeness, self-transcendence

Question 2

What is a personality disorder?

Answer 2

• inflexible or maladaptive, deviates from culture and causes functional impairment or social distress

Question 3

DSM Criteria

Answer 3

• Must involve 2+ of the following…
  
  • Cognition, affectivity, interpersonal functioning, impulse control
• ALSO…
  
  • Early onset, relative consistency over time, pervasive impairment across multiple life functions
  • R/O other poss conditions
• DSM is categorical (yes or no) BUT clinically can think of 5 Factor Model - spectrum of 5 areas (need for stability, extraversion, openness, agreeableness, conscientiousness)

Question 4

4 Neurotransmitters Involved

Answer 4

• NE - inc causes emotional reactivity, arousal, extraversion
• Serotonin - inc causes inhibition of impulse/affect
• Ach - inc causes lethargy/depression and dec exploration
• Dopamine - novelty seeking (nucleus accumbens) or histrionic traits

Question 5

Why study personality disorders

Answer 5

• Prevalent 10-15% pop (OCD, schizoid and paranoid most common but not most likely to prevent)
• Disabling
• Lethal - 1/3 suicides have co-morbid personality disorder
• Predictive - co-morbidity = poor prognosis

Question 6

Cluster A

Answer 6

Odd-Eccentric (“weird”) - detached and distrust

- Paranoid (suspicious) 
- Schizoid (little emotion) 
- Schizotypal (psychotic distortions) 

**Usually present w/ psychotic symptoms or b/c bizarre behavior

Question 7

Cluster B

Answer 7

Dramatic (“wild”) - intense, emotional, lack empathy

- Antisocial (no empathy, remorse) 
- Borderline Personality (fear of abandonment) 
- Narcissistic (exaggerated self importance) 
- Histrionic (emotional and provocative) 

**Often present w/ co-morbidities like depression, substance abuse, suicide attempt OR due to self injury or aggression

Question 8

Cluster C

Answer 8

Anxious/Fearful (“worried”) - avoidance, fear of rejection, excessive inhibition, submissive dependence

- Avoidant (fear rejection) 
- Dependent (submissive) 
- Obsessive-Compulsive (perfectionist)

Question 9

Treatment

Answer 9

• General Principles
  
  • Treat co-morbidity
  • Usually must be long-term
  • Get support for pt
• Psychotherapy&raquo_space; pharm (pharm just used for specific symptoms and short-term)
  
  • Esp use CBT
• Pharm
  - Anti-psychotics if dissociation/hallucinations/paranoia
  - SSRIs - if intense anger, emotional dys-regulation, impulsivity, aggression, rejection sensitivity, emptiness, social anxiety, etc
  - May also use lithium, anti-pscyhotics, MAOIs, anti-convulsants for impulsive behavior