Personality Disorders Flashcards
4 areas in which personality disorders manifest
- Cognition
- Affectivity: range, intensity, lability, appropriateness of emotional response
- Interpersonal functioning
- Impulse control
4 General dx criteria for personality disorder (DSM5)
- Enduring pattern of inner experience and behavior that deviates markedly from cultural expectations.
- Pattern is inflexible and pervasive across broad range of personal and social situations
- Pattern is stable, long duration, onset traced back to adolescence or early adulthood
- Lead to clinically sig distress or impairment
3 reasons important for clinicians to understand personality disorders
- Improves patient-provider relationship
- Enhances compliance
- Reduces pt stress
DSM-5 description of paranoid personality disorder
Pervasive mistrust/suspiciousness of others, think their motives are malevolent
DSM-5 Diagnostic criteria for paranoid personality disorder
Indicated by 4+ of:
- Suspects, without basis, that others are exploiting, harming, deceiving
- Preoccupied with unjustified doubts about loyalty or trustworthiness
- Reluctant to confide in others – unwarranted fear the info will be used maliciously against pt
- Reads hidden demeaning/threatening meaning into benign remarks/events
- Persistently bears grudges
- Perceives attacks on character or reputation that are not apparent to others, quick ot react angrily
- Recurring suspicions regarding fidelity of spouse/sexual partner
DSM-5 description of Schizoid personality disorder
Pervasive pattern of detachment from social relationships, restricted range of expression of emotions in interpersonal settings
DSM-5 Diagnostic criteria for schizoid personality disorder
Indicated by 4+ of:
- Doesn’t desire or enjoy close relationships
- Chooses solitary activities
- Little, if any, interest in sexual experiences
- Takes pleasure in few activities
- Lacks close friends or confidants outside of first-degree family
- Indifferent to praise/criticism
- Emotional coldness, detachment, flattened affect
- Not exclusively during course of other psych disorder (schizophrenia, bipolar, etc.)
- Can be considered “premorbid” to schizophrenia dx
DSM-5 Description of schizotypal personality disorder
Pervasive pattern of social/interpersonal deficits marked by acute discomfort with/reduced capacity for close relationships AND cognitive or perceptual distortions and eccentricities of behavior
DSM-5 Diagnostic criteria for schizotypal personality disorder
Indicated by 5+ of:
- Ideas of reference
- Odd beliefes or magical thinking
- Unusual perceptual experiences
- Odd thinking and speech (vague, circumstantial, etc.)
- Suspiciousness or paranoid ideation
- Inappropriate or constricted affect
- Behavior/appearance is odd/eccentric/peculiar
- Lacks close friends, confidants other than first-degree family
- Excessive social anxiety does not diminish with familiarity, tends to be associated with paranoid fears vs. negative judgemetn about self
- Not exclusively during course of other psych disorder (schizophrenia, bipolar, etc.)
- Can be considered “premorbid” to schizophrenia dx
DSM 5 description of antisocial personality disorder
- Pervasive pattern of disregard for/violation of the rights of others
DSM-5 Diagnostic criteria for antisocial personality disorder
- Occurring since age 15 but must at time of dx be at least 18
- Evidence of conduct disorder with onset before age 15
- Indicated by 3+ of:
- Failure to conform to social norms
- Deceitfulness (lying, aliases, conning for profit or pleasure)
- Impulsivity
- Irritability/aggressiveness: fights/assaults
- Reckless disregard for safety of self/others
- Consistent irresponsibility: repeated failure to work consistently or honor financial obligations
- Lack of remorse: indifferent to/rationalize having hurt, mistreated, stolen from another
DSM 5 description of conduct disorder
Repetitive and persistent pattern of behavior in which basic rights of others or major age-appropriate societal norms/rules are violated
DSM-5 Diagnostic criteria for conduct disorder
- Must be < 18 yo
- Manifested by 3+ of following in past 12 months:
1. Aggression to people/animals - Bullies, threatens, intimidates
- Initiates fights
- Physically cruel to people
- Physically cruel to animals
- Stole while confronting a victim (mugging, extortion)
- Raped
2. Destruction of property - Fire setting to cause damage
- Destruction of property other than fire
3. Deceitfulness or theft - Broken into someone else’s house, car, building
- Lies to obtain goods/favors or to avoid obligations
- Has stolen items without confronting a victim (shoplifting, forgery)
4. Serious violations of rules - Stays out past curfew starting < 13 yo
- Ran away from home overnight min 2 times or once if left for long period of time
DSM 5 description of borderline personality disorder
Pervasive pattern of instability of interpersonal relationships, self-image, and affect and marked impulsivity
DSM-5 Diagnostic criteria for borderline personality disorder
Indicated by 5+ of:
- Frantic efforts to avoid real/imagined abandonment
- Unstable/intense interpersonal relationships, alternation between idealization and devaluation
- Identity disturbance – unstable image or sense of self
- Impulsivity in two areas that are potentially self damaging (spending, sex, substance abuse, etc.)
- Recurrent suicidal behavior, gestures, threats, self-mutilation
- Affective instability – marked reactivity of mood
- Inappropriate, intense anger or difficulty controlling anger
- Transient, stress-related paranoid ideation/severe dissociate sx
DSM 5 description of histrionic personality disorder
Pervasive pattern of excessive emotionality and attention seeking
DSM-5 Diagnostic criteria for histrionic personality disorder
Indicated by 5+ of the following:
- Uncomfortable if not center of attention
- Interactions with others characterized by inappropriate sexually seductive or provocative behavior
- Rapidly shifting/shallow expression of emotions
- Consistently uses physical appearance to draw attn. to self
- Speech is excessively impressionistic/lacking in detail
- Self-dramatization, theatricality, exaggerated expression
- Suggestible
- Considers relationships to be more intimate than they are
DSM 5 description of narcissistic personality disorder
Pervasive pattern of grandiosity (fantasy or behavior), need for admiration, lack of empathy
DSM-5 Diagnostic criteria for narcissistic personality disorder
Indicated by 5+ of:
- Grandiose senses of self-importance: exaggerates achievements/talents
- Preoccupied with fantasies of unlimited success, power, brilliance, etc.
- Believes is special and unique, can only be understood by/associate with other special, high-status people
- Requires excessive admiration
- Sense of entitlement
- Interpersonally exploitative
- Lacks empathy
- Envious of others, believes others are envious of self
- Arrogant, haughty behavior/attitudes
DSM 5 description of avoidant personality disorder
Pervasive pattern of social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation
DSM-5 Diagnostic criteria for avoidant personality disorder
Indicated by 4+ of:
- Avoid occupational activities that involve sig interpersonal contact bc of fears of criticism, disapproval, rejection
- Unwilling to interact w/ppl unless certain of being liked
- Restraint in intimate relationships dt fear of being shamed/ridiculed
- Preoccupied with being criticized or rejected in social situations
- Inhibited in new interpersonal situations bc of feelings of inadequacy
- Views self as socially inept, personally unappealing, inferior
- Unusually reluctant to take personal risks, engage in new activities bc might be embarrassed
DSM 5 description of dependent personality disorder
Pervasive and excessive need to be taken care of, leads to submissive and clinging behavior and fears of separation
DSM-5 Diagnostic criteria for dependent personality disorder
Indicated by 5+ of:
- Difficulty making everyday decisions without advice/reassurance from others
- Needs others to assume responsibility for major life areas
- Difficulty expressing disagreement dt fear of loss of support/approval
- Difficulty initiating projects/doing things on own dt lack of self confidence (not lack of energy or motivation)
- Excessive lengths to obtain nurturance and support from others, to point will volunteer to do unpleasant things
- Uncomfortable/helpless when alone – exaggerated fears being unable to care for self
- Urgently seeks relationship as source of care when close relationship ends
- Unrealistically preoccupied with fears of being left to take care of self
DSM 5 description of obsessive-compulsive personality disorder
Pervasive pattern of preoccupation with orderliness, perfectionism, mental/interpersonal control at the expense of flexibility, openness, efficiency
DSM-5 Diagnostic criteria for obsessive-compulsive personality disorder
Indicated by 4+ of:
- Preoccupied with details, rules, lists, order, organization to extent that major point of activity is lost
- Perfectionism that interferes with task completion
- Excessively devoted to work/productivity while excluding leisure and friendships
- Over-conscientious, scrupulous, inflexible about matters of morality, ethics, values
- Unable to discard worn-out or worthless objects even when have no sentimental value
- Reluctant to delegate tasks or work with others unless do things exactly same way
- Miserly spending style toward self and others – money should be hoarded
- Rigid and stubborn
Clinician behavioral approach to paranoid personality disorder
- Admit mistakes
- Forthcoming and honest
- Professional but not overly warm (suspicious)
- Don’t confront
- Set limits
- Clearly explain procedures, medications, results
Clinician behavioral approach to schizoid personality disorder
- understand need for isolation
- min new contacts, intrusions
- maintain quiet, reassuring, considerate interest
- don’t insist on reciprocal responses
Clinician behavioral approach to schizotypal personality disorder
- Similar to Schizoid
- Do not ridicule or judge
- Respect need for privacy
- Pt often have misinterpretations of physical sx and tx
Clinician behavioral approach to antisocial personality disorder
- Set firm limits
- Try not to be manipulated
- High level of skepticism
- Don’t Rx excessive and/or unnecessary meds
Clinician behavioral approach to borderline personality disorder
- Be aware of and anticipate defenses
- Be aware often regress through self-sabotage of tx plans
- Open and continuous communication with other staff
- Maintain stable and calm reactions
- Gently comfort when needed
- Set fair and consistent limits on acting out
Clinician behavioral approach to histrionic personality disorder
- Similar to borderline
- Mental illness threatens sense of attractiveness and self-image
Clinician behavioral approach to narcissistic personality disorder
- Pt will handle criticism poorly
- Pt may be easily enraged
- Med illness can be blow to self-esteem
- Reinforce they are respected and appreciated
- Set limits on demanding behavior
Clinician behavioral approach to avoidant personality disorder
- Patience and understanding
- Med illnesses may be embarrassing
- Min new and unfamiliar staff contacts
- Respond with calm and reassuring demeanor
- Do not criticize
Clinician behavioral approach to dependent personality disorder
- Respect feelings of attachment
- Be careful when encouraging pt to change dynamics of abusive relationship
- When ill might be frustrated not being helped
- Be active in tx planning
Clinician behavioral approach to obsessive-compulsive personality disorder
- Allow pt to control care as much as possible
- Provide pt with information
- Avoid power struggles
- Understand their need for order and control
True/false: personality disorders are considered treatable
False -
generally considered not treatable
One tx for borderline personality disorder
CBT with specially trained psychotherapist
How to treat sx of generalized anxiety, depression, social anxiety, psychosis related to personality disorders?
pharmacotherapy as normal
