Personality disorders

Question 1

What is personality?

Answer 1

A person’s set of stable, predictable, emotional, and behavioral traits

Question 2

DSM-V criteria for personality disorder

Answer 2

1. Enduring pattern of behavior/inner experience that deviates from the person’s culture and is manifested in two or more of the following ways:
   - -Cognition
   - -Affect
   - -Interpersonal functioning
   - -Impulse control
2. The pattern:
   - -Is pervasive and inflexible in a range of situations
   - -Is stable and has an onset no later than adolescence or early adulthood
   - -Leads to significant distress in functioning
   - -Not accounted for by another condition

Question 3

What are the cluster A personality disorders?

Answer 3

Schizoid, schizotypal, and paranoid

Question 4

What are the cluster B personality disorders?

Answer 4

Narcissistic, anti-social, borderline, and histrionic

Question 5

What are the cluster C personality disorders?

Answer 5

Avoidant, dependent, and OCPD

Question 6

Treatment (in general) of personality disorders

Answer 6

Psychotherapy

Drugs have limited usefulness

Question 7

Diagnostic criteria for paranoid personality disorder

Answer 7

General distrust of others, beginning by early adulthood, present in a variety of contexts
At least 4 of:
–Suspicion that others are exploiting or deceiving him or her
–Preoccupation with doubts of loyalty or trustworthiness of friends or acquaintences
–Reluctance to confide in others
–Interpretation of benign remarks as threatening or demeaning
–Persistence of grudges
–Perception of attacks on his or her character that is not apparent to others
–Suspicions regarding fidelity of spouse

Question 8

Difference between paranoid PD and schizophrenia

Answer 8

PPD patients do not have fixed delusions and are not psychotic

Question 9

Diagnostic criteria for schizoid personality disorder

Answer 9

A pattern of voluntary social withdrawal and restricted range of emotional expression, beginning by early adulthood and present in a variety of contexts
Four or more of the following:
–Neither enjoying nor desiring close relationships
–Generally choosing solitary activities
–Little interest in sexual activity
–Taking pleasure in few activities
–Few close friends or confidants
–Indifference to praise or criticism
–Emotional coldness, detachment, or flattened affect

Question 10

Difference between schizoid PD and schizotypal PD

Answer 10

Patients with schizoid do not have the same eccentric behavior or magical thinking seen in patients with schizotypal personality disorder

Question 11

Diagnostic criteria for schizotypal personality disorder

Answer 11

Pattern of social deficits marked by eccentric behavior, cognitive or perceptual distortions, and discomfort with close relationships beginning by early adulthood
Five or more of: 
--Ideas of reference
--Odd beliefs or magical thinking
--Unusual perceptual experiences
--Suspiciousness
--Inappropriate or restricted affect
--Odd or eccentric appearance/behavior 
--Few close friends or confidants
--Odd thinking or speech
--Excessive social anxiety

Question 12

Treatment for schizotypal PD

Answer 12

Psychotherapy to help develop social skills

Short course of low-dose antipsychotics if necessary for transient psychosis

Question 13

Diagnostic criteria for antisocial PD

Answer 13

Pattern of disregard for and violation of the rights of others since age 15
Patients must be at least 18yo; history of behavior as a child/adolescent must be consistent with conduct disorder
Three or more of:
–Failure to conform to social norms by breaking law
–Deceitfulness/repeated lying/manipulating others
–Impulsivity/failure to plan ahead
–Irritability and aggressiveness/fights
–Recklessness and disregard for safety of self/others
–Irresponsibility/failure to sustain work or honor financial obligations
–Lack of remorse for actions

Question 14

Diagnostic criteria for borderline PD

Answer 14

Pervasive pattern of impulsivity and unstable relationships, affects, self-image, and behaviors, present by early adulthood and variety of contexts
At least 5 of:
–Frantic efforts to avoid real or imagined abandonment
–Chronic feelings of emptiness
–Unstable self-image
–Unstable, intense interpersonal relationships
–Impulsivity in at least 2 potentially harmful ways
–Recurrent suicidal threats or attempts or self-mutilation
–Unstable mood/affect
–Difficulty controlling anger
–Transient, stress-related paranoid ideation or dissociative symptoms

Question 15

Treatment for borderline personality disorder

Answer 15

Dialectical behavioral therapy

Drugs for depressive or psychotic symptoms if necessary