Personality Disorders Flashcards
List the diagnostic criteria for a personality disorder
Enduring pattern of inner experience and behaviour that deviates markedly from expectation of individual’s culture by >=2
- cognition
- affectivity
- interpersonal functioning
- impulse control
Enduring pattern is inflexible and pervasive across a broad range of personal and social situations
Cause distress or impairement
Pattern is stable and long term with onset traced back to adolescents
No other condition
Discuss the development of a personality disorder
Temperament
- includes the biological/genetic component of personality
Environmental
- adverse childhood events increase the risk of developing an adverse childhood event
Discuss the different classes of personality disorders
Cluster A
- odd or eccentric behaviour
- schizoid, schizotypal, and paranoid
Cluster B:
- dramatic, emotional or erratic behaviour
- antisocial, borderline, histrionic, narcissitic
Cluster C
- anxious or fearful
- obsessive compulsive, dependent, avoidant
List the diagnostic criteria for schizoid
pervasive pattern of detachment from social relationships and restricted range of expression as shown by >=4
- neither desire nor enjoy close relationships
- always choose solitary activities
- little to no interest in sexual experiences
- takes pleasure in few or no activities
- lack close friends
- appear indifferent to praise or critiscm
- show emotional coldness
List the diagnostic criteria for schizotypal
- greatest risk for developing schizophrenia (10-20%)
Pervasive pattern of acute discomfort with and reduced capacity for social relationships, cognitive and perceptual distortions and eccentriticies of behaviour as seen by >=4 - ideas of reference
- odd belief or magical thinking
- unusual perceptual illusions
- odd thinking
- suspiciousness or paranoid ideation
- inappropriate affect
- behaviour is odd, eccentric and peculiar
- lack of close friend
- excessive social anxiety
Treatment - with antipschotic if have psychotic episode
List the diagnostic criteria for paranoid
Pervasive distrust of others interpreting other motives as malevolent by >=4
- suspect that others are exploiting, harming, deceiving
- preoccupied unjustful doubts about loyalty
- reluctant to confide in others due to fear that they will use information against them
- reads hidden demeaning or threatening remarks
- bears grudges
- perceives attacks
- recurrent suspicions
List the risk factors for paranoid personality disorder
- hearing impaired
- new immigrants
- minority groups
List distinguishing presenting features in Cluster A personality disorders
- all can have brief psychotic episode when under stress Schizoid - asocial loner - bland, distant Schizotypal - superstitious and preccupied with paranormal behaviour - odd, eccentric - cannot display affect Paranoid - pathologically jealous - need to control intimate relationships - labile range of affect
List the diagnostic criteria for histrionic
- least impairing personality disorder
Pervasive excessive emotionality and attention seeking by >=5 - uncomfortable in situation not the centre of
- interaction with other by inappropriate sexually seductive or provocative behaviour
- rapidly shifting and shallow expression
- use physical appearence to draw attention to oneself
- style of speech is excessively impressionistic and lacks detail
- self dramatization and exaggerated emotional expression
- suggestible
- consider relationship to be more intimate then they are
List the diagnostic criteria for antisocial personality disorder
Pervaisve disregard for and violation of rights of others by >=3 of the following
- repeated law breaking that are grounds for arrest
- deceitfulness
- impuslivity
- irritable and aggressive
- reckless disregard for safety of self and others
- consistent irresponsibility
- lack of remorese
Patter began by age 15 and are older then 18
Discuss the risk and preventive factors for antisocial personality
Risks
- Genetic MAO-A low activity gene
- utero exposure to smoking or starvation
- poverty for youth with aggressive behaviour
- childhood onset of conduct disorder
Prevention
- reduce adverse childhood events
- reduce childhood punishment
- early intervention for child with at risk mom
- secondary prevention of preventing children with aggressive behaviour to progress by education and positive parenting
List the diagnostic criteria for narcissitic
Pervasive pattern of grandiosity, need for admiration, and lack of empathy shown by >=5
- Grandiose
- Preoccupied with fantasies of unlimited success
- belief that they are special
- require excessive admiration
- sense of entitlement
- interpersonally exploitative
- envious of others
- arrogant
List the diagnostic criteria for borderline
Pervasive pattern of instability of interpersonal relationships, self image, affect and marked impulsivity by >=5
- affective instability due to marked reactive of mood
- feeling of emptiness
- intense anger and difficulty controlling anger
- extreme effort to avoid real or imagined abandonment
- intense interpersonal relationship with idealization and devaluation
- impulsivity with damaging consequences
- recurrent suicidal behaviour
- identity disturbance: inconsistent view of self
- paranoid ideation
List good and poor prognostic factors for borderline
Good
- high global functioning
Poor
- concurrent substance dependence
List acute risk and acute protective factors for suicide in borderline
Risk - major depression - substance use - discharge from hospital - recent negative news Good - crisis skills - administration of low dose antipsychotics - hospitalization - alternative solutions to problems that trigger suicide
List key presenting features for Cluster B Disorders
Histrionic
- do anything for centre of attention
- spend time on grooming to impress others
Antisocial
- lawbreaking
- only involved with medical care when substance use, note for missing work, wanting prescibtion or assessment to avoid criminal responsibility
- callous, cynical of feelings and rights of others
- decision made rapidly with no thought of consequences
Narcisstic
- boastful and pretentious
- devaluation of others
- narcissism is normal in teens but outgrow
Borderline
- intense fear of abandonment
- dramatic shift in views in relationships and of self
- unstable and reactive mood
List the comorbidities seen with cluster B disorders
Histrionic - somatic symptoms disorder - MDD Antisocial - depressive - anxiety - substance use - ADHD and learning disability Narcissitic - depression - substance use - anorexia Borderline - depression, bipolar, dysthymia - anxiety disorder - substance use - eating disorder
Discuss the treatment for borderline
Life Threatening Conditions - suicidality - substance use - eating disorder Dialectical Behavioural Therapy - solve probelm that trigger painful emotion to feel better and tolerate stressful situation Treat Comorbidities - SSRI - mood stabilizer (Abilify) - Insominia (Quetiapine, Olanzapine)
List the risk factors for and comorbidities associated with self injurious behaviour
Risks - low SES - Childhood adverse events - increased risk of suicidal behaviour - recent negative life event Comorbid Psych Disorder - BPD - depression - alcohol abuse - eating disorder
Discuss the pathophysiology of self injurous behaviour
Emotionally vulnerable with invalidating environment result in emotional dysregulation -> self injurous behaviour relieve from intense painful emotion
- also for punishment or attention
Discuss the management of self injurous behaviour
- validate psychological distress and way of wanting tor educe pain
- address event that caused stress
List the diagnostic criteria for Obsessive compulsive personality disorder
Pervasive pattern of preoccupation with orderliness, perfectionism, and mental/interpersonal control at expense of flexibility, openness and efficiency with >=4
- preoccupation with details
- perfectionism that interfere with task completion
- devoted to work and productivity
- over-conscientious and inflexible about matter of ethic or values
- unable to discard worn out or worthless object
- reluctant to delegate tasks
- rigidity and stubborness
List the diagnostic criteria for avoidant
Pervasive pattern of social inhibition, feeling of inadequacy, and hypersensitivity with >=4
- avoid occupational activities that involve interpersonal contact
- unwilling to get involved with people unless certain will be liked
- show restraint within intimate relationships
- preoccupied with being critized
- inhibited in new interpersonal situation
- view self as inept and inferior to others
- not likely to take personal risk
List the diagnostic criteria for dependent
Pervasive need to be taken care of that leads to submissive and clinging behaviour with fear of separation by >=5
- difficulty making every day decisions without advice
- need others to take responsibility in one own life
- difficulty expressing disagreement
- difficulty initiating projects
- go to great lengths to gain nuturance from others
- uncomfortable when alone
- urgently seek another relationship when one ends
- unrealistically preoccupied with fear of being left to care of oneself
Discuss the presentation in Cluster C
OCPD - most functional/may be hyperfunctional - appear as controlling - very organized - difficulty relaying feelings Avoidant - similar to social phobia but in all scenarios - are shy and inhibited - sensitive to expression of others Dependent - self perception of inability to function by oneself - passive, self-doubting, pessimistic - depend on parent or spouse
