Personality Disorders Flashcards
What are personality traits?
enduring patterns of perceiving, relating to and thinking about the environment and oneself
exhibited in a wide range of important social/personal contexts
What is a personality disorder?
enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individuals’s culture
In a pt with a personal disorder, how can maladaptive patterns manifest?
(in two or more of the following)
cognition- how we perceive/interpret internal and external events
affect
interpersonal interactions
impulse control
What are some traits of personal disorder?
- inflexible and pervasive over broad range of situations
- clinically significant distress/impairment
- pattern stable over time, traced back to at least adolescence or early adulthood
What are the “clusters: of personality disorders
10 disorders divided into 3 “clusters”
A: paranoid, schizoid, Schizotypal
B: antisocial, borderline, histrionic, Narcissistic
C: Avoidant, dependent, obsessive compulsive
Describe cluster A personality disorders
odd or eccentric
Includes: Paranoid, Schizoid, Schizotypal
Describe cluster B personality disorders
dramatic, acting out, problem with empathy
Includes: Antisocial, borderline, histrionic, narcissistic
Describe cluster C personality disorders
prominent anxiety and novelty avoidance
Includes: Avoidant, Dependent, Obsessive-compulsive
Describe general personality disorder
An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s cultures.
leads to clinically significant distress or impairment in social, occupation or other important areas of functioning.
What are some diagnostic features of general personality disorder?
- inflexible/maladaptive personality traits –> sig. functional impairment/distress
- belief/behaviors deviate from culture norm
- long term pattern (must have developed by early adulthood)
- distinguished from behavior/thinking during stressors or transient mental states
- Ind. doesn’t see personality traits as problematic
If a personality disorder is dx in a pt younger than 18 y/o the disorder must be present for at least….
one year
When diagnosing a personality disorder you must be mindful of…
- person’s culture
- don’t confuse acclimating to new culture with PD
- don’t confuse with religious belief
- should only be dx if defining features/long-term behavior before age 18
Describe Paranoid PD
Pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood
Pts with paranoid PD may believe that…
- suspects w/out basis that others are exploiting, harming or deceiving them
- reluctant to confide in others due to fear that info will be used maliciously
- reads hidden demeaning or threatening meanings into benign remarks or events
- persistent bears grudges
etc.
Tx for personality disorder?
these pts rarely present for tx
little research but individual therapy may help
early termination of tx is common
Pharmacotherapy for paranoid PD?
Generally NONE- contraindication, arouses unnecessary suspicion
But if severe anxiety –> anti-anxiety med
if severe agitation/delusional thinking –> anti-psychotic
Describe Schizoid PD
pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning in early adulthood
Characteristics of schizoid PD?
- neither desires not enjoys close relationships
- almost always chooses solitary activities
- little interest in sexual experiences w/ another person
- takes pleasure if few if any activities
- lacks close friends
- shows emotional coldness, detachment or flattened affectivity
How does schizoid PD differ from avoidant PD?
their indifference to others
Tx for schizoid PD
psychotherapy
these pts are unlikely to seek treatment, usually short in nature
Characteristics of Schizotypal PD
- ideas of reference
- odd beliefs, magical thinking inconsistent with cultural norms
- illusions
- odd thinking/speech
- suspicious/paranoid ideation
- inappropriate/constricted affect
- lack of close friends
- odd/eccentric behavior, often unkempt manner of dress
- excessive social anxiety
Tx for schizotypal PD?
pts usually seek tx for associated anxiety/depression
Describe antisocial PD
Pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years
Characteristics of antisocial PD?
- failure to conform to social norms, repeatedly performing acts that are grounds for arrest
- deceitfulness, lying, using aliases
- impulsivity
- irritability/aggressiveness
- disregard for safety of others
- lack of remorse
In order to dx antisocial PD disorder…
Pt must be at least 18 y/o with sxs onset before 15 y/o
Antisocial PD epidemiology
related with low SES in urban settings
more common in males
Treatment for antisocial PD
dif. working w/ these pts due to tendency to blame others, and low tolerance for frustration
cognitive behavioral therapy
+/- meds to reduce agression- NONE routinely used
Describe borderline PD
Pervasive pattern of instability of interpersonal relationships, self image, and affects and marked impulsivity, beginning by early adulthood and present in a anxiety
Characteristics of borderline PD
- frantic efforts to avoid real/imagined abandonment
- unstable and intense interpersonal relationships
- unstable self image
- impulsivity (spending, sex, substance abuse, etc.)
- recurrent SI
- marked mood reactivity
- chronic feelings of emptiness
- inappropriate intense anger
- transient, stress related paranoid ideation
Pts with…may react in despair to clinician’s announcing the end of the hour, panic or fury when someone important to them is just a few minutes late
Borderline personality disorder
How do pts with borderline PD often present?
to ER in crisis
clinician should contact the pts PCP or primary therapist
Borderline PD tx
should be encouraged to find additional support within community rather than presenting to ED
- psychotherapy
- SSRIs (unless comorbid bipolar d/o)
Characterisitics of Histrionic PD
- discomfort with not being center of attention
- often inappropriate sexual seductiveness
- labile/shallow expression of emotions
- uses appearance to draw attention to self
- impressionistic speech
- melodramatic, theatrical emotional reactivity
- highly suggestible
- sees relationships as more intimate than they actually are
In a pt with….PD opinions and feelings are easily influenced by others and by current fads
Histrionic PD
Tx for Histrionic PD
individual psychotherapy
Tx for obsessive compulsive PD
focused on short term sxs
work on coping mechanisms
CBT not effective
meds not indicated but +/- SSRI
Characterisitics of Narcissistic PD
- grandiose sense of self importance
- fantasies of unlimited success, power, beauty, love
- belief that they are special and should only associate with similarly elite ind.
- requires excessive admiration
- sense of entitlement
- interpersonally exploitative
- lacks empathy
- envious of other or believes others are envious of the
- arrogant, haughty
Tx for narcissistic PD?
tx for sxs related to crises or other diagnoses
psychotherapy
Characteristics of avoidant PD
- avoids interpersonal contact for fear of criticism or rejection unless certain of being liked
- restraint with intimacy for fear of shame or ridicule
- preoccupation with criticism or rejection in social situation
- self image: socially inept, unappealing or inferior
- avoids personal risks, new activities for fear of embarrassment
Tx for avoidant PD
psychotherapy
most effective when: short term, oriented toward finding solutions to specific life problems
Characteristics for dependent PD?
- trouble with everyday decisions-need for excessive advice
- needs others to assume responsibility for most major ares of their life
- dif. disagreeing with others due to fear of losing approval/support
- dif. initiating projects
- uncomfortable/helpless when alone
- urgently seeks another relationship when close relationship ends
Tx for dependent PD
short term psychotherapy aimed at specific problem solving
meds contraindicated unless a
Characterisitics of obsessive-compulsive PD?
- preoccupation with rules, lists, details, order
- perfectionism interferes w/ task completion
- excessive devotion to work/productivity-> excludes leisure/social interactions
- over conscientious and inflexible on matters of morality, ethics or valves
- excessive hoarding of worthless items
- reluctance to delegate or work with others
- miserly spending style
- rigidity and stubbornness
