Personality Disorders Flashcards
1
Q
Personality Traits
A
- Enduring patterns of perceiving, relating to, and thinking about onself and the environment exhibited in wide range of contexts.
2
Q
Personality Disorder
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- Enduring pattern of inner experience and behaviour that markedly deviates from expectations. It is pervasive, inflexible, early onset, stable, and leads to distress and impairment.
3
Q
Critieria for personality disorder
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- An enduring pattern of inner experiences and behaviours that deviates markedly from the expectations of one’s culture. Pattern in manifested in two or more of the following.
- Cognition - way of perceiving and interpreting self, others, and events
- Affectivity - range, intensity, lability, and appropriateness of emotional response.
- Interpersonality
- Impulse control
- Enduring pattern is inflexible and pervasive across broad range of personal and social situations
- Leads to clinically significant distress or impairment in functioning
- Pattern is stable and of long duration and can be traced back to adolescence or early adulthood
- Not better explained by another mental disorder
- Not better explained by a substance or other medical condition
4
Q
Development and Course of Personality Disorders
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- By definition, must be enduring and stable pattern, so tends to become evident by adolescence or young adulthood
- Some become less evident with age (APD, BPD) while others fo not (OCPD, schizotypal).
- Due to normal changes in childhood, a personality disorder can only be diagnosed in someone <18 if they have had features for ≥ 1 year (except APD which can only be diagnosed in individuals ≥18)
5
Q
Personality Disorder Clusters
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- Cluster A- Odd or eccentric behaviour
- Paranoid
- Schizoid
- Schizotypal
- Cluster B - Dramatic, emotional, or erratic behaviour
- Antisocial
- Borderline
- Histrionic
- Narcissistic
- Cluster C - Anxious or fearful behaviour
- Avoidant
- Dependent
- Obsessive compulsive
6
Q
Paranoid Personality Disorder
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- Pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts as indicated by 4+ of the following:
- Suspects, without sufficient basis, that other are exploiting, harming, or decieving them
- Preoccupied with unjustified doubts about the loyalty or trustworthiness of friends
- Is reluctant to confide in others because of fear that it will be used against them
- Reads hidden or demeaning or threatening meaning into benign remarks or event s
- Persistently bears grudges
- Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react
- Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partern
- Does not occur exclusively during course of schizophrenia, bipolar disorders, or depressive disorders wit psychotic features and not due to another medical condition
- Associated features:
- Difficult to get along with and have problems in close relationships
- May appear cold, guarded, and secretive. They are often critical of others, unable to collaborate, and have difficulty accepting criticism from others.
- Due to their quickness to counterattack in response to threats, they may become frequently involved in legal disputes
- In response to stress individuals may experience very brief psychotic episodes (mins to hours)
- May be the premorbid antecedent of delusionals disorder or schizophrenia
7
Q
Schizoid Personality Disorder
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- Pervasive pattern of detachment from social relationships and restricited range of expressions of emotions in interpresonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by 4+ of the following
- Neither desires nor enjoys close relationships, including being part of a family
- Almost always chooses solitary activities
- Has litte, if any, interest in having sexual experiences with another person
- Takes pleasure in few, if any, activities
- Lacks close friends or confidants other than first degree relatives
- Appears indifferent to praise and criticism of others
- Shows emotional coldness, detachment, or flattened affectivity
- Does not occur exclusively during course of schizophremia, bipolar, depressive disorder with psychotic featues, another psychotic disorder, or autism spectrum disorder and is not due to another medical condition
- Associated features:
- Difficulty expressing anger, even in response to provocation
- React passively to adverse circumstances and have difficulty responding appropriately to important life events
- Few friends and relationships
- May experience very brieft psychotic episodes in response to stress
- Most often co-occurs with schizotypal, paranoid, and avoidant personality disorder
8
Q
Schizotypal Personality Disorder
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- Pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and exxentricities of behaviour, beginning by early adulthood and present in a variety of contexts, as indicated by 5+ of the following:
- Ideas of reference (exluding delusions of reference)
- Odd beliefs or mafica thinking that influences behaviour and is inconssistent with subcultural norms
- Unusual preceptua experiences, including bodily illusions
- Odd thinking and speech - vague, circumstantial, metaphorical, overelaborate, or stereotypes
- Suspicious or paranoid ideation
- Inappropriate or constricted affect
- Behaviour or appearance that is odd, eccentric, or peculiar
- Lack of close friends or confidents other than first degreee relatives
- Excessive social anxiety that does not dimish with familiarity and tends to be associated with paranoid fears rathers than negative judgments about self
- Does not occur exclusively duing course of schizophrenia, bipolar, depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder
- Associated features:
- Patients tends to seek treatment for associated features or anxiety or depression, rather than for personality disoder
- May experience very brief psychotic episodes in response to stress
9
Q
Antisocial Personality Disorder
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- Pervasive pattern of disregard for and violation of rights of others, occuring since 15, as indicated by 3+ of the following:
- Failure to conform to social norms with respect to lawful behaviours, as indicated by repeatedly performing acts that are ground for arrest
- Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
- Impulsivity or failure to plan ahead
- Irritability and aggressiveness, as indicated by repeated physical fights or assaults
- Reckless disregard for safety of self or others
- Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behaviour or honor financial obligations
- Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
- ≥18
- Evidence of conduct disorder with onset before 15
- Does not occur exclusively during course of schizophrenia or bipolar disorder
- Associatd features:
- Lack empathy, and are callous, cynical, and contemptuous of the feeling, rights, and sufferings of others
- Inflated and arrogant self-appraisal
- May have superficial charm
- May be irresponsible and exploitative in sexual relationships
- More likely than general population to die of violent means
- Often have features that meet criteria for others personality disorders (BPD, histronic, narcissistic)
- Higher prevalence in those with substance abuse and in prison
10
Q
Borderline Personality Disorder
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- A pervasive pattern of instability on interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and presents in variety of contexts as indicated by 5+ of the following:
- Frantic efforts to avoid real or imagined abandonment
- Pattern of unstable and intense interpersonal relationship characterized by alternating between extremes of idealization and devaluation
- Identity disturbance: Markedly and persistently unstable self-image or sense of self
- Impulsivity in at least 2 areas that are potentially self-damaging
- Recurrent suicidal behaviours, gestures, or threats, or self-mutilating behaviour
- Affective instability due to a marked reactivity of mood
- Chronic feelings of emptiness
- Inappropriate, intense anger or difficulty controlling anger
- Transient, stress-related paranoid ideation or severe dissociative symptoms
- Associated features:
- Pattern of undermining themselves at moment before goal is realized
- Development of psychotic-like symptoms during times of stress - hallucinations, body-image distortions, ideas of reference, hyphnagogic phenoma
- Recurrent job losses, interrupted education, and separation or divorce is common
- Premature death from suicide may occur
- History of physical and sexual abuse, neglect, hostile conflict, and early parental loss is common
- Common comorbidities - depression, bipolar, SUB, eating disorder (Bulimia), PTSD, and ADHD
- Prevalence - 10% in outpatient and 20% among inpatients
11
Q
How to distinguish BPD from other mood disorders
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- Distinguish from mood disorders, dysthmic disoder, and cyclothymia based on efforts to avoid abandonment, unstable relationships with alternating between idealization and devaluating, identity disturbance, impulsivity in potentially self-damaging areas, chronic feelings of emptiness, and inappropriately intensive anger or difficulty controlling anger.
12
Q
Histronic Personality Disorder
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- Pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a varity of contexts, as indicated by 5+ of the following:
- Is uncomfortable in situations in which he or she is not centre of attention
- Interaction with others is often characterized by inappropriate sexually seducative or provocative behaviour
- Displays rapidly shifting and shallow expression of emotions
- Consistently used physical appearance to draw attention to self
- Has a style of sppech that is excessively impressionistic and lacking in detail
- Shows self-dramatization, theatrically, and exaggerted expression of emotion
- Is suggestible
- Considers relationships to be more intimate than they actually are
- Associated features:
- Difficulty achieving emotional intimacy in romantic relationship
- May see to control partner through emotional manipulation or seductiveness while displaying dependency
- Impaired relationhips with same sex friends due to sexually provocative interpersonal style
- Become depressed and upset when not center of attention
- Crave novelty, stimulation, and excitement
- Co-occurance with BPD, narcissistic, antisocial, and dependent personality disorder
13
Q
Narcissistic Personality Disorder
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- Pervasive pattern of grandiosity, need for admiration and lack of empathy, beginning by early adulthood and present in variety of contexts, as indicated by 5+
- Grandiose sense of self-importance
- Preoccurpied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
- Believes that they are special and unique and can only be understool by, or should associated with other special or high status people
- Requries excessive admiration
- Has sense of entitlement
- Is interpersonally exploitative
- Lacks empathy
- Envious of others or believes others are envious of him
- Shows arrogant, haughty behaviours, or attitudes
- Associated features
- Vulnerbility to self-esteem making them very sensitive to injury from criticism or defeat
- Impaired interpersonal relationships due to entitlement, need for admiration, and disregard of others
- Vocational functionig can be low due to unwillingness to take risks in situatons where defeat is possible
- Co-occurance of histrionic, BPD, APD, and paranoid
14
Q
Avoidant Personality Disorder
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- Pervasive pattern of social inhibition, feelings of inadequancy and hypersenitivity to negative evaluation, beginning in early adulthoos, and present in variety of contexts as indicated by 4+ of the following
- Avoids occupation activities that involve significant interpersonal contact because of fears of criticism, dissappoval or rejection
- Unwilling to get involved with people unless certain of being liked
- Shows restraint within intimate relationships because of fear of being shamed or ridiculed
- Is preoccupied with being criticized or rejected in social situations
- Inhibited in new interpersonal situations because of feelings of inadequacy
- Views seld as socially inept, personally unappealking or inferior to others
- Reluctant to take personal risks of enage in any new activites because they may prove embarrassing
- Associated features:
- Vigilantly appraise movements and expressions of others
- Shy, timid, and isolated
- Low self-esteem and hypersentivity to rejection leads to restricted interpsional contacts
- Desire affection and acceptance
- Co-occuring disoders - depressive, bipolar, anxiety (social)
- Often also diagnosed with dependent personality disorder, BPD, and cluster A personality disorders.
15
Q
Dependent Personality Disorder
A
- Pervasive and excessive need to be taken care of that leads to submissive and clining behaviour and fear of separation, beigging by early adulthood and present in a variety of contexts, as indicated by 5+ of the following
- Has difficulty making everday decisions without an excessive amount of advice and reassurance from others
- Needs to tohers to assume responsbility for most major areas of their life
- Has difficulty expressing disagreement with others because of fear of loss of support or approval
- Has difficulty initiating projects or doing things on his or her own
- Goes to excessive lengths to obtain nurturance and support from others
- Fears uncomfortable or helpless when alone because of axaggerated fears of being unable to care for themselves
- Urgently seeks another relationship as a source of care and support when a close relationships ends
- Is unrealisitically preoccurped with fears of being left to take care of themselves
- Associated features:
- Often characterized by pessism and self-doubt
- Tends to belittle abilities and assets
- May constantly refer to themselves as stupid
- May take criticism and disapproval as proof of their worthlessness and loose faith in themselves
- May seek overprotection and dominance from others
- May avoid positions of responsibility and become anxious when faced with decisions
- Social relationships may be limtied to those that are depends
- Increase risk of depressive disorders, anxiety disorders, and adjustment disorders
- Often oc-occurs with BPD, avoidant, and histronic
