Personality Disorders Flashcards
diagnostic criteria for personality disorders
an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the person’s culture
- pattern is inflexible
- leads to clinically significant distress or impairment
- long standing, stable
what areas does personality disorders affect?
cognititon: ways of perceiving and interpreting self and toher people
affectivity: range, intensity, liability and appropriateness
interpersonal functionign
impulse control
3 clusters of specific disorder
- mad
- bad
- sad
Cluster A: Mad (odd or eccentric)
schizoid
schizotypal
paranoid
Cluster B: Bad (dramatic)
histrionic
narcissistic
borderline
antisocial
Cluster C: Sad (anxious)
avoidant
dependent
obessive-compulsive
diagnosis - 2/6 answered yes in this screening could mean they have one
- Experiences marked shifts in mood
- Feels inadequate when not the center of attention
- Actions directed toward obtaining immediate satisfaction
- Reluctant to confined in others because of unwarranted fear that information will be used against
- Excessive social anxiety
- Unwilling to get involved with people unless certain of being liked
epidemiology
10-20% of general population 30-50% of psych patients
onset in adolescence and established by adulthood
epidemiology: borderline, avoidant and dependent are more common in
female
epidemiology: antisoical is more common in
males
consequences of personality disorder
o Highly negative outcomes for personal, academic, work and social arenas
o Increased risk of early death due to suicide, homicide and accidents
neurobiology of schizotypal
low platelet MAO activity and distubed smooth pursuit eye movement
neurobiology of antisocial and borderline
low CSF 5-HIAA (serotonin metabolite)
Paranoid
• Pervasive pattern of distrust and suspiciousness
• Need 4/7 criteria
• Some suggest part of schizophrenia spectrum
• May be related to learned suspiciousness and mistrust
o Behavior leads to others being cautious and deceptive – fulfills patients fantasies
Paranoid treatment
• Rarely seek treatment – usually because they mistrust everyone
• Seen most often for anxiety and depression
• Important for clinician to respect the patient
o Avoid group therapy
o Antipsychotics may be beneficial
Schizoid
- Profound inability to form relationships and to respond to others in a meaningful way
- Usually have no close relationships
- Choose solitary activites
- Rarely experience strong emotions
- Show lack of interest in sexual relations with a person
- Display constricted affect
Schizoid treatment
o Rarely seek help
o Will be seen for mood disorder, anxiety or substance use
o Lack insight and motivation
o Day program may be good options
Schizotypal
• Seen in relatives of schizophrenic patients o Part of the spectrum • Needs at least 5 symptoms: 1. Peculiar behavior 2. Odd speech/thinking 3. Unusual perceptions 4. Social isolation 5. Mild paranoia 6. Constricted affect 7. Magical beliefs
Schizotypal treatment
• Social skills training is beneficial
o Can learn how to stop doing odd/eccentric things
• Atypical antipsychotics may be useful
Antisocial
• Previously called psychopathy or sociopathy
• Characterized by: early onset of behaviors such as lying, cheating, fighting, problems with adults
o Fire-setting, cruelty to children and animals
• Person must be at least 18 for the diagnosis
• Symptoms should not be limited to psychotic or manic episodes
• Chronic disorder but over thirty years, thirty percent showed improvement
Antisocial criteria to meet
• Meet 3 of the criteria:
- Poor job performance
- Domestic abuse
- Criminal behavior
- Pathological lying
- Aliases
Antisocial treatment
• Death rate increased due to natural causes as well as suicide, homicide and accidents
o Lithium carbonate and phenytoin reduce aggression and assaultiveness in prisoners
o Atypical antipsychotics, carbamazepine and valproate have also shown some benefit
o Benzodiazepines are contraindicated
• Comorbid axis I should be treated
• CBT has been used to help the person evaluate distorted beliefs and attitudes
• Family therapy may be helpful as well
Borderline
• Was earlier though to be a milder version of schizophrenia
• Relatively stable in long-term follow up
• ¾ engage in deliberate self-harm
o 10% commit suicide
• Positive prognosis associated with higher intelligence, self-discipline and better social supports
• Negative prognosis include anger, suspiciousness and antisocial behavior
o A version of mood disorder
Borderline criteria
o Mood instability
o Intense and unstable interpersonal relationships
o Impulsivity
o Inappropriate/intense anger
o Lack of control
o Recurrent suicidal threats/gestures
o Self-mutilating
o Marked and persistent identity disturbance
o Chronic feelings of emptiness or boredom
o Frantic attempts to avoid real or imagined abandonment
• Need 5/9 criteria
Borderline Treatment
• In therapeutic treatment intense transference can develop
o Counter transference can cause issues such as anger or guilt
o Boundary violations need to be monitored closely
• CBR can be helpful
o One type called DBT (dialectical behavior therapy) reduced long-term self-harm, hospitalization rates and anger dyscontrol
• Systems traning for emotional predictability and problem solving (STEPPS) can also be helpful
o A form of psychoeducation, delivered in a group setting
• Pharmacotherapy should focus on target symptoms such as fluoxetine for depression
o Low dose antipsychotics and mood stabilizers may also be beneficial
Histrionic criteria
• At least 5 criteria: 1. Self-dramatization 2. Attention seeking 3. Excessive concern with appearance 4. Rapidly shifting and shallow emotions 5. Inappropriately sexually seductive or provocative 6. Excessively impressionistic speech • 2% prevalence, more common in females
Histrionic
- Originally based on the concept of excessive emotionality and attention seeking
- 2% prevalence, more common in females
- May be linked to somatization disorder and antisocial personality in family studies
Histrionic treatment
psychodynamic therapy treatment of choice
Narcissistic
- Develop as a response to parental failure in conveying empathy to a child’s need for admirations leads to self-centeredness?
- Relatively uncommon – no cases in a community sample of 800 people
- Some clinicians view it as being a part of other disorder
- Usually present for a narcissistic injury: thus anger or depression, not having expectations met
Narcissistic criteria
- Develop as a response to parental failure in conveying empathy to a child’s need for admirations leads to self-centeredness?
- Relatively uncommon – no cases in a community sample of 800 people
- Some clinicians view it as being a part of other disorder
- Usually present for a narcissistic injury: thus anger or depression, not having expectations met
Narcissistic treatment
- Treatment ranges from psychodynamic to interpersonal to CBT
- Patients are hard to work with
Avoidant
• Characterized by inhibition, introversion and anxiety
o Low self-esteem, hypersensitivity to rejections, apprehension and mistrust, social awkwardness and timidity, self-consciousness, fear of being embarrassed in public are other symptoms
• Not clear if avoidant personality is clearly different from social phobia
Avoidant treatment
• Group therapy helps patients overcome awkwardness and anxiety
o Assertiveness and social skills training helps
o Systematic desensitization helps with anxiety and shyness
o CBT corrects dysfunctional attitudes
o Benzos reduce anxiety
o SSRIs help with social phobia
Dependent
• Relies excessively on others for emotional support in adult life. Excessive need to be taken care of that leads to submissive or clinging behavior
• Related to oral fixation
o Others relate to disruption of attachment in early life
o Or to overprotectiveness and parental authorittianis
• Common in people with mental or physical illness
Dependant criteria
• Need five or more of:
o Difficulty making everday decisions
o Needs others to assume responsibly
o Difficulty expressing disagreement
o Difficulty initiating projects
o Going to excessive lengths to obtain support
o Feels helpless when alone
o Unrealistically preoccupied with fears of being left alone
o Tries to find relationship for support as soon as one ends
Dependent treatment
- CBT is recommended to encourage emotional group assertiveness and effective decision-making
- Assertiveness and social skills training may also be helpful
Obsessive-Compulsive
Pervasive pattern of orderliness and perfectionism at the expense of flexibility and efficiency
• Analytic interpretation is anal fixation
• Not a clear relationship between OCD and OCP
• OCD patients are much more likely to be distressed by their symptoms, call them pathological
• Seen in up to 8% of the population
• Major depression and other anxiety disorders are common comorbidities
Obsessive-Compulsive criteria
Pervasive pattern of orderliness and perfectionism at the expense of flexibility and efficiency
• Analytic interpretation is anal fixation
• Not a clear relationship between OCD and OCP
• OCD patients are much more likely to be distressed by their symptoms, call them pathological
• Seen in up to 8% of the population
• Major depression and other anxiety disorders are common comorbidities
Obsessive-Compulsive treatment
• Psychodynamic treatment has been recommended by some experts but these patients even though they are able to develop insight do not develop emotion
o CBT may help with developing the tolerance of various shades of gray in the real world
o SSRI’s may help with ritualization and perfectionism if that is a major issue
