Personality Disorders Flashcards

You may prefer our related Brainscape-certified flashcards:
1
Q

What is a personality?

A

One’s set of stable, predictable, emotional, & behavioral traits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are personality disorders?

A

Involve enduring patterns of inner experience & behavior that deviate markedly from expectations of an individual’s culture

They are pervasive, maladaptive, & cause significant impairment in social or occupational functioning

Patients often lack insight about their problems
- Their symptoms are either ego-syntonic or viewed as immutable

Patients are vulnerable to developing symptoms of other mental disorders during stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Diagnosis & DSM-V criteria of personality disorders

A

CAPRI:

  • Cognition
  • Affect
  • Personal relations
  • Impulse control

Enduring pattern of behavior / inner experience that deviates from the person’s culture & is manifested in 2 or more of the following ways:

  • Cognition
  • Affect
  • Interpersonal functioning
  • Impulse control

Pattern:

  • Is pervasive & inflexible in broad range of situations
  • Stable & has an onset no later than adolescence or early adulthood
  • Leads to significant distress in functioning
  • Is not accounted for by another mental / medical illness or by use of substance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Epidemiology / etiology of personality disorders

A

International prevalence is 6%

Vary by gender

Many will meet criteria for more than 1 disorder
- Should be classified as having all the disorders for which they qualify

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the clusters of personality disorders?

A

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  • Patients seem eccentric, peculiar, or withdrawn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 w/ mood disorders

CLUSTER C

  • Avoidant, dependent, & obsessive-compulsive
  • Patients seem anxious or fearful
  • Familial association w/ anxiety disorder

Other specified / unspecified personality disorder includes characteristics of personality disorder that do not meet full criteria for any of the other personality disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Etiology of personality disorders

A

Biological, genetic, & psychosocial factors during childhood & adolescence contribute to development of personality disorders

Prevalence of some personality disorders in monozygotic twins is several times higher than in dizygotic twins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Treatment of personality disorders

A

Generally very difficult to treat, especially since few patients are aware that they need help

Disorders tend to be chronic & lifelong

Pharmacologic treatment has limited usefulness except in treating comorbid mental conditions (e.g. MDD)

Psychotherapy is usually the most helpful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is cluster A personality disorder?

A

Perceived as eccentric or odd by others

Can have psychotic symptoms

Paranoid, schizoid, & schizotypal personality disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is paranoid personality disorder (PPD)?

A

Have pervasive distrust & suspiciousness of others & often interpret motives as malevolent

Tend to blame their own problems on others & seem angry & hostile

Often characterized as being pathologically jealous, which leads them to think that their sexual partners or spouses are cheating on them

Clinical example:

  • 30 yo man says wife has been cheating on him
  • Claims that he was laid off from previous job because he did a better job than his boss
  • Has initiated several lawsuits
  • Refuses couples therapy because he believes the therapist will side w/ his wife
  • Believes neighbors are critical of him
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Diagnosis & DSM-V criteria of PPD

A

Diagnosis requires general distrust of others

Begins by early adulthood & present in variety of contexts

At least 4 of the following:

  1. Suspicion (without evidence) that others are exploiting or deceiving him/her
  2. Preoccupation w/ doubts of loyalty / trustworthiness of friends / acquaintances
  3. Reluctance to confide in others
  4. Interpretation of benign remarks as threatening or demeaning
  5. Persistence of grudges
  6. Perception of attacks on his/her character that is not apparent to others; quick to counterattack
  7. Suspicions regarding fidelity of spouse / partner
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Epidemiology of PPD

A

Prevalence: 2-4%

More commonly diagnosed in men than in women

Higher incidence in family members of schizophrenics

This disorder may be misdiagnosed in minority groups, immigrants, & deaf individuals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Differential diagnosis of PPD

A

Schizophrenia

  • Patients w/ PPD do not have any fixed delusions & are not frankly psychotic
  • May have transient psychosis under stressful situations

Social disenfranchisement & social isolation

  • Without social support, persons can react w/ suspicion to others
  • Differential in favor of PPD can be assisted by assessment of others in close contact w/ the person, who may identify they consider as excess suspicion, etc.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Course / prognosis of PPD

A

Disorder usually has chronic course, causing lifelong marital & job-related problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Treatment of PPD

A

Psychotherapy (treatment of choice)

Group psychotherapy should be avoided due to mistrust & misinterpretation of others’ statements

Patients may benefit from short course of antispychotics for transient psychosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is schizoid personality disorder?

A

Have lifelong pattern of social withdrawal

Often perceived as eccentric & reclusive

Quiet & unsociable

Have constricted affect

Have no desire for close relationships & prefer to be alone

Unlike avoidant personality disorder, patients w/ schizoid personality disorder prefer to be alone

Clinical example:

  • 45 yo scientist works in lab most of day
  • Has no friends, according to coworkers
  • Not been able to keep job because of failure to collaborate w/ others
  • Expresses no desire to make friends & content w/ single life
  • No evidence of thought disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Diagnosis & DSM-V criteria of schizoid personality disorder

A

Pattern of voluntary social withdrawal & restricted range of emotional expression, beginning by early adulthood & present in variety of contexts

4 or more of the following must also be present:

  1. Neither enjoying nor desiring close relationships (including family)
  2. Generally choosing solitary activities
  3. Little (if any) interest in sexual activity w/ another person
  4. Taking pleasure in few activities (if any)
  5. Few close friends or confidants (if any)
  6. Indifference to praise or criticism
  7. Emotional coldness, detachment, or flattened affect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Epidemiology of schizoid personality disorder

A

Prevalence: 3-5%

Diagnosed more often in men than women

May see increased prevalence in relatives of individuals w/ schizophrenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Differential diagnosis of schizoid personality disorder

A

Schizophrenia
- Patients w/ schizoid PD don’t have fixed delusions / hallucinations

Schizotypal personality disorder

  • Do not have same eccentric behavior or magical thinking seen in patients w/ schizotypal PD
  • Schizotypal patients are more similar to schizophrenic patients in terms of odd perception, thought, & behavior
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Course of schizoid personality disorder

A

Usually chronic course

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Treatment of schizoid personality disorder

A

Lack insight for individual psychotherapy

May find group therapy threatening

May benefit from day programs or drop-in centers

Antidepressants if comorbid major depression is diagnosed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is schizotypal personality disorder?

A

Have pervasive pattern of eccentric behavior & peculiar thought patterns

Often perceived as strange & odd

Disorder was developed out of observation that certain family traits predominate in first-degree relatives of those w/ schizophrenia

Clinical example:

  • 35 yo man dresses in wizard costume every weekend w/ friends as part of live action role-playing community
  • Spends great deal of time on computers set up in basement for video games & to “detect the presence of ET communications in space”
  • Has no auditory or visual hallucinations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Diagnosis & DSM-V criteria of schizotypal personality disorder

A

Pattern of social deficits marked by eccentric behavior, cognitive or perceptual distortions, & discomfort w/ close relationships, beginning by early adulthood & present in variety of contexts

5 or more of the following must be present:

  1. Ideas of reference (excluding delusions of reference)
  2. Odd beliefs or magical thinking, inconsistent w/ cultural norms
  3. Unusual perceptual experiences (such as bodily illusions)
  4. Suspiciousness
  5. Inappropriate or restricted affect
  6. Odd or eccentric appearance or behavior
  7. Few close friends or confidants
  8. Odd thinking or speech (vague, stereotyped, etc.)
  9. Excessive social anxiety

Magical thinking may include:

  • Belief in clairvoyance or telepathy
  • Bizarre fantasies or preoccupations
  • Belief in superstitions

Odd behaviors may include:
- Involvement in cults or strange religious practices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Epidemiology of schizotypal personality disorder

A

Prevalence: 4-5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Differential diagnosis of schizotypal personality disorder

A

Schizophrenia
- Not frankly psychotic (though can become transiently so under stress), nor do they have fixed delusions

Schizoid personality disorder
- Do not have same eccentric behavior seen in patients w/ schizotypal PD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Course of schizotypal personality disorder

A

Course is chronic, w/ small minority developing schizophrenia

Premorbid personality type for patient w/ schizophrenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Treatment of schizotypal personality disorder

A

Psychotherapy is treatment of choice to help develop social skills training

Short course of low-dose antipsychotics if necessary (for transient psychosis)
- May help decrease social anxiety & suspicion in interpersonal relationships

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are cluster B personality disorders?

A

Often emotional, impulsive, & dramatic

Antisocial, borderline, histrionic, & narcissistic personality disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is antisocial personality disorder?

A

Are exploitive of others & break rules to meet their own needs

Lack empathy, compassion, & remorse for their actions

Impulsive, deceitful, & often violate law

Frequently skilled at reading social cues & can appear charming & normal to others who meet them for the first time & do not know their history

Clinical example:

  • 30 yo unemployed man has been accused of killing 3 senior citizens after robbing them
  • Surprisingly charming in interview
  • In adolescence, he was arrested several times for stealing cars & assaulting other kids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Diagnosis & DSM-V criteria of antisocial personality disorder

A

CONDUCT:

  • Capriciousness
  • Oppressive
  • Deceitful
  • Unlawful
  • Carefree
  • Temper

Pattern of disregard for & violation of rights of others since age 15
- Often associated w/ violations of the law

Patients must be at least 18 years old for this diagnosis

  • History of behavior as child/adolescent must be consistent w/ conduct disorder
  • Patients may have history of being abused (physically, sexually) as child or history of hurting animals or starting fires

3 or more of the following should be present:

  1. Failure to conform to social norms by committing unlawful acts
  2. Deceitfulness / repeated lying / manipulating others for personal gain
  3. Impulsivity / failure to plan ahead
  4. Irritability & aggressiveness / repeated fights or assaults
  5. Recklessness & disregard for safety of self or others
  6. Irresponsibility / failure to sustain work or honor financial obligations
  7. Lack of remorse for actions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Epidemiology of antisocial personality disorder

A

Prevalence: 3% in men, 1% in women

There is higher incidence in poor urban areas & in prisoners, but no racial difference

Genetic component:
- Increased risk among first-degree relatives

31
Q

Differential diagnosis of antisocial personality disorder

A

Drug abuse:

  • Necessary to ascertain which came first
  • Patients who began abusing drugs before their antisocial behavior started may have behavior attributable to effects of their addiction
32
Q

Course of antisocial personality disorder

A

Usually has chronic course, but some improvement of symptoms may occur as patient ages

Many have multiple somatic complaints

Many have coexistence of substance use disorders and/or major depression

There is increased morbidity from substance use, trauma, suicide, or homicide

33
Q

Treatment of antisocial personality disorder

A

Psychotherapy is generally ineffective

Pharmacotherapy may be used to treat symptoms of anxiety or depression, but use caution due to high addictive potential of these patients

34
Q

What is borderline personality disorder (BPD)?

A

Have unstable moods, behaviors, & interpersonal relationships

Fear abandonment & have poorly formed identity

Relationships begin w/ intense attachments & end w/ slightest conflict

Aggression is common

Impulsive & may have history of repeated suicide attempts / gestures or episodes of self-mutilation

Have higher rates of childhood physical, emotional, & sexual abuse than general population

Clinical example:

  • 23 yo medical student attempted to cut her wrist because things did not work out w/ man she had been dating over past 3 weeks
  • States that guys are jerks & “not worth her time”
  • Often feels that she is “alone in this world”
35
Q

Diagnosis & DSM-V criteria of BPD

A

IMPULSIVE

  • Impulsive
  • Moody
  • Paranoid under stress
  • Unstable self-image
  • Labile, intense relationships
  • Suicidal
  • Inappropriate anger
  • Vulnerable to abandonment
  • Emptiness

Commonly use defense mechanism SPLITTING
- View others & themselves as all good or all bad

Pervasive pattern of impulsivity & unstable relationships, affects, self-image, & behaviors, present by early adulthood & in variety of contexts

At least 5 of the following must be present:

  1. Frantic efforts to avoid real or imagined abandonment
  2. Unstable, intense interpersonal relationships (e.g. extreme love-hate relationships)
  3. Unstable self-image
  4. Impulsivity in at least 2 potentially harmful ways (spending, sexual activity, substance use, binge eating, etc.)
  5. Recurrent suicidal threats or attempts or self-mutilation
  6. Unstable mood / affect
  7. Chronic feelings of emptiness
  8. Difficulty controlling anger
  9. Transient, stress-related paranoid ideation or dissociative symptoms
36
Q

Epidemiology of BPD

A

Prevalence: up to 6%

Diagnosed 3 times more often in women than men

Suicide rate: 10%

The name borderline comes from patient’s being on the borderline of neurosis & psychosis

37
Q

Differential diagnosis of BPD

A

Schizophrenia
- Do not have frank psychosis (may have transient psychosis)

Bipolar II
- Mood swings experienced in BPD are rapid, brief, moment-to-moment reactions to perceived environmental or psychological triggers

38
Q

Course of BPD

A

Variable, but many develop stability in middle age

High incidence of coexisting major depression and/or substance use disorders

Increased risk of suicide

39
Q

Treatment of BPD

A

PSYCHOTHERAPY
- Dialectal behavior therapy (DBT) - treatment of choidfe (includes CBT, mindfulness skills, group therapy)

PHARMACOTHERAPY

  • Treat psychotic or depressive symptoms may be helpful
  • Has been shown to be more useful in BPD than in any other personality disorder
40
Q

What is histrionic personality disorder (HPD)?

A

Exhibit attention-seeking behavior & excessive emotionality

Are dramatic, flamboyant, & extroverted

Unable to form long-lasting, meaningful relationships

Often sexually inappropriate & provocative

Clinical example:

  • 33 yo scantily clad woman complains that her fever feels like “she is burning in hell”
  • She vividly describes how the fever has affected her work
41
Q

Diagnosis & DSM-V criteria of HPD

A

Often use defense mechanism of regression
- Revert to child-like behaviors

Pattern of excessive emotionality & attention seeking

Present by early adulthood & in variety of contexts

At least 5 of the following must be present:

  1. Uncomfortable when not the center of attention
  2. Inappropriately seductive or provocative behavior
  3. Rapidly shifting, but shallow expression of emotion
  4. Uses physical appearance to draw attention to self
  5. Speech that is impressionistic & lacking in detail
  6. Theatrical & exaggerated expression of emotion
  7. Easily influenced by others or situation
  8. Perceives relationships as more intimate than they actually are
42
Q

Epidemiology of HPD

A

Prevalence: 2%

Women are more likely to have HPD than men

43
Q

Differential diagnosis of HPD

A

Borderline personality disorder

  • BPD are more likely to suffer from depression, brief psychotic episodes, & attempt to suicide
  • HPD patients are more functional
44
Q

Course of HPD

A

Usually chronic, with some improvement of symptoms w/ age

45
Q

Treatment of HPD

A

PSYCHOTHERAPY

  • Supportive
  • Problem solving
  • Interpersonal
  • Group

PHARMACOTHERAPY
- Treat associated depressive or anxious symptoms as necessary

46
Q

What is narcissistic personality disorder (NPD)?

A

Have sense of superiority, need for admiration, & lack of empathy

Consider themselves “special” & will exploit others for their own gain

Despite their grandiosity, these patients often have fragile self-esteem

Characterized by inflated sense of entitlement

  • Often “fishing for compliments”
  • Become irritated & anxious when they are not treated as important

Clinical example:

  • 48 yo company CEO rushes to ED after automobile accident
  • Does not let residents operate on him & requests the Chief of trauma surgery because he is “vital to company”
  • Makes several business phone calls in ED to stay on “top of his game”
47
Q

Diagnosis & DSM-V criteria of NPD

A

Pattern of grandiosity, need for admiration, & lack of empathy

Begin by early adulthood & present in variety of contexts

5 or more of the following must be present:

  1. Exaggerated sense of self-importance
  2. Preoccupation w/ fantasies of unlimited money, success, brilliance, etc.
  3. Believes that he/she is “special” or unique & can associate only w/ other high-status individuals
  4. Requires excessive admiration
  5. Has sense of entitlement
  6. Takes advantage of others for self-gain
  7. Lacks empathy
  8. Envious of others or believes others are envious of him/her
  9. Arrogant / haughty
48
Q

Epidemiology of NPD

A

Prevalence: up to 6%

49
Q

Differential diagnosis of NPD

A

Antisocial personality disorder

  • Both types exploit others, but NPD patients want status & recognition
  • Antisocial patients want material gain or simply subjugation of others
  • NPD become depressed when they don’t get recognition they think they deserve
50
Q

Course of NPD

A

Usually has chronic course

Higher incidence of depression & midlife crises since these patients put such a high value on youth & power

51
Q

Treatment of NPD

A

PSYCHOTHERAPY
- Treatment of choice

PSYCHOPHARMACOLOGY
- Antidepressants may be used if comorbid mood disorder is diagnosed

52
Q

What are cluster C personality disorders?

A

Appear anxious & fearful

Avoidant, dependent, & obsessive-compulsive personality disorders

53
Q

What is avoidant personality disorder?

A

Have pervasive pattern of social inhibition & intense fear of rejection

Will avoid situations in which they may be rejected

Fear of rejection is so overwhelming that it affects all aspects of their lives

Avoid social interactions & seek jobs in which there is little interpersonal contact

These patients desire companionship, but are extremely shy & easily injured

Has large overlap w/ social anxiety disorder (social phobia)
- May be same syndrome / spectrum

Clinical example:

  • 30 yo postal worker rarely goes out w/ her coworkers & often makes excuses when they ask her to join them because she is afraid they will not like her
  • Wishes to go out & meet new people, but she is too “shy”
54
Q

Diagnosis & DSM-V criteria of avoidant personality disorder

A

AFRAID:

  • Avoids occupation w/ others
  • Fear of embarrassment & criticism
  • Reserved unless they are certain that they are liked
  • Always thinking rejection
  • Isolates from relationships
  • Distances self unless certain that they are liked

Pattern of social inhibition, hypersensitivity, & feelings of inadequacy since early adulthood

At least 4 of the following must be present:

  1. Avoids occupation that involves interpersonal contact due to fear of criticism & rejection
  2. Unwilling to interact unless certain of being liked
  3. Cautious of interpersonal relationships
  4. Preoccupied w/ being criticized or rejected in social situations
  5. Inhibited in new social situations because he/she feels inadequate
  6. Believes he/she is socially inept & inferior
  7. Reluctant to engage in new activities for fear of embarrassment
55
Q

Epidemiology of avoidant personality disorder

A

Prevalence: 2.4%

Equally frequent in males & females

56
Q

Differential diagnosis of avoidant personality disorder

A

Schizoid personality disorder

  • Patients w/ avoidant PD desire companionship but are extremely shy
  • Patients w/ schizoid PD have little or no desire for companionship

Social anxiety disorder (social phobia)

  • Both involve fear & avoidance of social situations
  • If symptoms are integral part of patient’s personality & have been evident since before adulthood, PD is more likely diagnosis
  • Social anxiety disorder involves fear of embarrassment in particular setting, whereas avoidant PD is overall fear of rejection & sense of inadequacy
  • Patient can have both disorders concurrently & should carry both diagnoses if criteria for each are met

Dependent personality disorder

  • Avoidant PD cling to relationships, similar to dependent PD
  • Avoidant PD are slow to get involved, whereas dependent patients actively & aggressively seek relationships
57
Q

Course of avoidant personality disorder

A

Course is usually chronic, although may remit w/ age

Particularly difficult during adolescence, when attractiveness & socialization are important

Increased incidence of associated anxiety & depressive disorders

If support system fails, patient is left very susceptible to depression, anxiety, & anger

58
Q

Treatment of avoidant personality disorder

A

Psychotherapy, including assertiveness & social skills training is most effective

Group therapy may be beneficial

SSRIs may be prescribed for comorbid social anxiety disorder or major depression

59
Q

What is dependent personality disorder (DPD)?

A

Have poor self-confidence & fear of separation

Have excessive need to be taken care of & allow others to make decisions for them

Feel helpless when left alone

Clinical example:

  • 40 yo man who lives w/ parents has trouble deciding how to get his car fixed
  • Calls father at work several times to ask very trivial things
  • Has been unemployed over past 3 years
60
Q

Diagnosis & DSM-V criteria of DPD

A

OBEDIENT:

  • Obsessive about approval
  • Bound by other’s decisions
  • Enterprises are rarely initiated due to their lack of self-confidence
  • Difficult to make own decisions
  • Invalid feelings while alone
  • Engrossed w/ fears of self-reliance
  • Needs to be in a relationship
  • Tentative about decisions

Regression is often seen in people w/ DPD
- Defined as going back to a younger age of maturity

Many people w/ debilitating illnesses can develop dependent traits
- To be diagnosed w/ DPD, feature must manifest in early adulthood

Pattern of excessive need to be taken care of that leads to submissive & clinging behavior

At least 5 of the following must be present:

  1. Difficulty making everyday decisions without reassurance from others
  2. Needs others to assume responsibilities for most areas of his/her life
  3. Difficulty expressing disagreement because of fear or loss of approval
  4. Difficulty initiating projects because of lack of self-confidence
  5. Goes to excessive lengths to obtain support from others
  6. Feels helpless when alone
  7. Urgently seeks another relationship when one ends
  8. Preoccupied w/ fears of being left to take care of self
61
Q

Epidemiology of DPD

A

Prevalence: approx. <1%

Women > men

62
Q

Differential diagnosis of DPD

A

Avoidant personality disorder:

  • Avoidant PD cling to relationships, similar to dependent PD
  • Avoidant PD are slow to get involved, whereas dependent patients actively & aggressively seek relationships

Borderline & histrionic personality disorders

  • DPD usually have long-lasting relationship w/ 1 person on whom they are dependent
  • Borderline & histrionic PD are often dependent on other people, but they are unable to maintain long-lasting relationship
63
Q

Course of DPD

A

Usually has chronic course

Prone to depression, particularly after loss of person on whom they are dependent

Difficulties w/ employment since they can’t act independently or without close supervision

64
Q

Treatment of DPD

A

PSYCHOTHERAPY
- Particularly cognitive-behavioral, assertiveness, & social skills training are treatment of choice

PHARMACOTHERAPY
- May be used to treat associated symptoms of anxiety or depression

65
Q

What is obsessive-compulsive personality disorder (OCPD)?

A

Have pervasive pattern of perfectionism, inflexibility, & orderliness

Become so preoccupied w/ unimportant details that they are often unable to complete simple tasks in timely fashion

Appear stiff, serious, & formal w/ constricted affect

Often successful professionally, but have poor interpersonal skills

Clinical example:

  • 40 yo secretary has been recently fired because of her inability to prepare some work projects in time
  • According to her, they were not in right format & she had to revise them 6 times
  • This has happened before, but she feels that she is not given enough time
66
Q

Diagnosis & DSM-V criteria of OCPD

A

Pattern of preoccupation w/ orderliness, control, & perfectionism at expense of efficiency & flexibility

Present by early adulthood & in variety of contexts

At least 4 of the following must be present:

  1. Preoccupation w/ details, rules, lists, & organization such that major point of activity is lost
  2. Perfectionism that is detrimental to completion of task
  3. Excessive devotion to work
  4. Excessive conscientiousness & scrupulousness about morals & ethics
  5. Will not delegate tasks
  6. Unable to discard worthless objects
  7. Miserly spending style
  8. Rigid & stubborn
67
Q

Epidemiology of OCPD

A

Prevalence: 1-2%

Men are 2x more than women

68
Q

Differential diagnosis of OCPD

A

Obsessive-compulsive disorder (OCD):

  • OCPD don’t have recurrent obsessions or compulsions that are present in oCD
  • Symptoms of OCPD are ego-syntonic rather than ego-dystonic (as in OCD)
  • OCD patients are aware that they have a problem & wish their thoughts & behaviors would go away

Narcissistic personality disorder

  • Both involve assertiveness & achievement
  • NPD motivated by status
  • OCPD motivated by work itself
69
Q

Course of OCPD

A

Unpredictable course

Some have comorbid OCD (most do not)

70
Q

Treatment of OCPD

A

PSYCHOTHERAPY

  • Treatment of choice
  • CBT may be particularly useful

PHARMACOTHERAPY

  • May be used to treat associated symptoms as necessary
  • SSRIs often decrease intrusive thoughts associated w/ OCD
71
Q

What is the diagnosis of personality change due to another medical condition?

A

Refers to persistent personality change from previous pattern due to direct pathophysiological result of medical condition:

  • Head trauma
  • Strokes
  • Epilepsy
  • CNS infections
  • Neoplasms

Subtypes:

  • Labile
  • Disinhibited
  • Aggressive
  • Apathetic
  • Paranoid
72
Q

What is the diagnosis of other specified personality disorder?

A

Reserved for personality disorder that does not meet the full criteria for any of the disorders, but where the clinician CHOOSES to communicate specific reason that presentation does not meet criteria for any specific personality disorder:
- Mixed personality disorder

73
Q

What is the diagnosis of unspecified personality disorder?

A

Used for personality disorder that does not meet full criteria for any of the disorders, but where the clinician chooses NOT to specify the reason that the criteria re not met for any specific personality disorder:
- Not enough info to make more specific diagnosis