Personality Disorders

Question 1

What is required for a diagnosis of a Personality Disorder?

Answer 1

A. Enduring pattern on inner experience and behavior that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas:

• Cognition (perception and interpretation of self, others and events)
• Affect (the range, intensity, liability and appropriateness of emotional response)
• Interpersonal functioning
• Impulse control

B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.

Question 2

What is required to diagnose a person < 18 y/o with a personality disorder?

What disorder cannot be diagnosed in a person < 18 y/o by definition?

Answer 2

Symptoms must be present for > 1 year.

Antisocial personality disorder.

Question 3

In general, what is the rule of thumb regarding diagnosis of a personality disorder < 18 y/o?

Which patient population is a personality disorder diagnosis highly unreliable?

Answer 3

Personality disorders should not be diagnosed in childhood or adolescents because personality development is not complete; symptomatic traits may not persist into adulthood.
Rule of thumb: a diagnosis cannot be made until at least 18 y/o.

Elderly patients

Question 4

Cluster A Personality Disorder includes which disorders?

Answer 4

“Weird” - odd or eccentric.

• Paranoid personality disorder: characterized by irrational suspicions and mistrust of others.
• Schizoid personality disorder: lack of interest in social relationships, indifferent to praise/criticism of others, have little pleasure in activities, lack close friends/confidant aside from 1st-degree relatives.
• Schizotypal personality disorder: odd behavior or thinking, odd beliefs, vague/stereotypical speech, social anxiety.

Question 5

Cluster B Personality Disorders includes which disorders?

Answer 5

Dramatic, emotional or erratic disorders.

• Antisocial personality disorder: pervasive disregard for law and rights of others.
• Borderline personality disorder: extreme “black or white” thinking, unstable relationships, highly variable self-image, identity and behavior.
• Histrionic personality disorder: pervasive attention‐seeking behavior including inappropriate sexual seductiveness and shallow or exaggerated emotions.
• Narcissistic personality disorder: a pervasive pattern of grandiosity, need for admiration, and a lack of empathy.

Question 6

What are possible features of Antisocial Personality Disorder?

Answer 6

Repeated law violations.

Pervasive lying and deception.

Physical aggressiveness.

Reckless disregard for safety of self and others.

Consistent irresponsibility.

Lack of remorse.

Question 7

Which sex is at a greater risk for Antisocial Personality Disorder?

Does it have a genetic basis?

They might be at risk for…

Answer 7

3x more common in men than women.

Yes.

Anxiety disorders
Substance abuse
Somatization disorder
Pathological gambling

Question 8

What sex is at a greater risk for Borderline Personality Disorder?

What is a major feature of these patients?

What must be done when treating these patients?

They are often victims of what?

What is a common comorbid condition?

Answer 8

Women are at a 3x greater risk than men.

Very manipulative.

Rigid boundaries must be set: (1) constant reminders of pt. guidelines and responsibilities, (2) will often split staff/docs against each other.

Often are victims of sexual abuse.

Major depression.

Question 9

What is “la belle indifference”?

What disorder is it seen in?

What “group” of disorders is it particularly associated with?

Answer 9

A naive, inappropriate lack of emotion or concern for the perceptions by others of one’s disability, usually seen in persons with conversion disorder.

Histrionic personality disorder.

Somatoform disorders.

Question 10

Which sex is more likely to have Narcissistic Personality Disorder?

What are these patients at risk for?

Answer 10

50-75% are male.

At risk for:

• anorexia nervosa
• substance abuse
• depression

Question 11

Cluster C includes which Personality Disorders?

Answer 11

Anxious or fearful disorders.

Avoidant personality disorder: social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation and avoidance of social interaction.

Dependent personality disorder: pervasive psychological dependence on other people.

Obsessive-compulsive personality disorder (not the same as obsessive-compulsive disorder): characterized by rigid conformity to rules, moral codes and excessive orderliness.

Question 12

What is the difference between Schizoid Personality Disorder and Avoidant Personality Disorder?

Avoidant Personality Disorder patients are paralyzed by…

Why is it not included in Cluster A disorders?

Answer 12

Patients with avoidant personality disorder desire relationships with others.

“Paralyzed by their fear and sensitivity into social isolation.”

These patients are shy, but not as “odd” as Cluster A-types.

Question 13

Which sex is more common in OCPD?

Answer 13

2x more common in men than women

Question 14

“Multiple Personality Disorder” =

Answer 14

Dissociative identity disorder

Question 15

What is required for a diagnosis of Dissociative Identity Disorder?

Which sex is more common?

Patients often have a history of…

Answer 15

Presence of 2 or more distinct identities or personality states.

Women > men

History of sexual abuse.

Question 16

How is Psychodyamic Psychotherapy approached?

How often is it done?

Answer 16

Psychodynamic psychotherapy

• examines how patients perceive events.
• assumes perceptions are shaped by early life.
• facilitate development of a more adaptive mode of perception and response.

Several times a week to once a month. Makes use of transference!

Question 17

How is Cognitive Behavioral Therapy (CBT) approached?

How often is it done?

Answer 17

Deals with how people think about their world and their perception of it.

Limited to episodes of 6-20 weeks, once weekly.

Question 18

How is Group Psychotherapy approached?

How often is it done?

Answer 18

Allows interpersonal psychotherapy to display itself among peer patients.

Usually once weekly over a course that may range from several months to years.

Question 19

What is Dialectical Behavioral Therapy (DBT)?

What is it used to treat the most?

Answer 19

Manual-based therapy on the development of coping skills to improve affective stability and impulse control and reducing self-harm behavior.

Used for borderline personality disorder most, but is now being used with other Cluster B disorders.

Question 20

What is the role of meds in treating patients with personality disorders?

Which meds are used?

Answer 20

Used in adjunct with psychotherapy, so patients may engage in psychotherapy!

• Treats symptom clusters such as:
• cognitive-perceptual symptoms
• affective dysregulation
• impulsive-behavioral dyscontrol

SSRIs and newer antidepressants.
Anticonvulsants: Valproic acid for impulse control.
Atypical antipsychotics for transient psychotic periods. (however, response is usually less than in true psychotic patients).

Question 21

What are the major complications of personality disorders?

Answer 21

Suicide
Substance abuse
Accidental injury
Depression
Homicide - mostly paranoid and antisocial personality disorders.

Question 22

What are the progression of each Cluster of disorders?

Which Cluster is considered to have the worst prognosis?

Answer 22

Clusters A and B tends to become less severe and intense in mid-age and late life.
Cluster C characteristics tend to becomee xagerrated in later life.

Cluster B has the worst prognosis: susceptibility to substance abuse, poor impulse control, suicide.