Personality Disorders Flashcards
What is a personality?
One’s set of stable, predictable, emotional, & behavioral traits
What are personality disorders?
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
Diagnosis & DSM-V criteria of personality disorders
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
Epidemiology / etiology of personality disorders
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
What are the clusters of personality disorders?
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- Patients seem eccentric, peculiar, or withdrawn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
Etiology of personality disorders
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
Treatment of personality disorders
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
What is cluster A personality disorder?
Perceived as eccentric or odd by others
Can have psychotic symptoms
Paranoid, schizoid, & schizotypal personality disorders
What is paranoid personality disorder (PPD)?
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
Diagnosis & DSM-V criteria of PPD
Diagnosis requires general distrust of others
Begins by early adulthood & present in variety of contexts
At least 4 of the following:
- Suspicion (without evidence) that others are exploiting or deceiving him/her
- Preoccupation w/ doubts of loyalty / trustworthiness of friends / acquaintances
- Reluctance to confide in others
- Interpretation of benign remarks as threatening or demeaning
- Persistence of grudges
- Perception of attacks on his/her character that is not apparent to others; quick to counterattack
- Suspicions regarding fidelity of spouse / partner
Epidemiology of PPD
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
Differential diagnosis of PPD
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.
Course / prognosis of PPD
Disorder usually has chronic course, causing lifelong marital & job-related problems
Treatment of PPD
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
What is schizoid personality disorder?
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
Diagnosis & DSM-V criteria of schizoid personality disorder
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:
- Neither enjoying nor desiring close relationships (including family)
- Generally choosing solitary activities
- Little (if any) interest in sexual activity w/ another person
- Taking pleasure in few activities (if any)
- Few close friends or confidants (if any)
- Indifference to praise or criticism
- Emotional coldness, detachment, or flattened affect
Epidemiology of schizoid personality disorder
Prevalence: 3-5%
Diagnosed more often in men than women
May see increased prevalence in relatives of individuals w/ schizophrenia
Differential diagnosis of schizoid personality disorder
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
Course of schizoid personality disorder
Usually chronic course
Treatment of schizoid personality disorder
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
What is schizotypal personality disorder?
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
Diagnosis & DSM-V criteria of schizotypal personality disorder
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:
- Ideas of reference (excluding delusions of reference)
- Odd beliefs or magical thinking, inconsistent w/ cultural norms
- Unusual perceptual experiences (such as bodily illusions)
- Suspiciousness
- Inappropriate or restricted affect
- Odd or eccentric appearance or behavior
- Few close friends or confidants
- Odd thinking or speech (vague, stereotyped, etc.)
- 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
Epidemiology of schizotypal personality disorder
Prevalence: 4-5%
Differential diagnosis of schizotypal personality disorder
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
Course of schizotypal personality disorder
Course is chronic, w/ small minority developing schizophrenia
Premorbid personality type for patient w/ schizophrenia
Treatment of schizotypal personality disorder
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
What are cluster B personality disorders?
Often emotional, impulsive, & dramatic
Antisocial, borderline, histrionic, & narcissistic personality disorders
What is antisocial personality disorder?
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
Diagnosis & DSM-V criteria of antisocial personality disorder
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:
- Failure to conform to social norms by committing unlawful acts
- Deceitfulness / repeated lying / manipulating others for personal gain
- Impulsivity / failure to plan ahead
- Irritability & aggressiveness / repeated fights or assaults
- Recklessness & disregard for safety of self or others
- Irresponsibility / failure to sustain work or honor financial obligations
- Lack of remorse for actions