Personality Disorders Flashcards
When is the onset for personality disorders?
adolescence or early adulthood
Do personality disorders tend to be stable over time?
yes
Why might there be dilemmas in making distinctions between the personality disorders and other diagnoses?
High rate of comorbidity with other psychiatric disorders
How are the Three clusters of personality disorders grouped?
according to common symptomatology
What is Cluster A?
- Paranoid, schizoid, and schizotypal personality disorders
- characterized by odd or peculiar behavior
What is Cluster B?
- Antisocial, borderline, histrionic, and narcissistic personality disorders
- present with flamboyant or dramatic behavior
What is Cluster C?
- Avoidant, dependent, obsessive-compulsive personality disorders
- characterized primarily by anxiety or fear
Etiology of personality disorders is a combination of what?
- Genetic factors affecting serotonin system and stress reactions
- Deficits in function of the prefrontal cortex & structures related to emotion and impulse control
- Structural and functional deficits especially in limbic and paralimbic brain areas, and the cognitive-executive brain regions
- Parental influences—parents with anhedonia more likely to have children with Personality disorders
- Childhood trauma; and adverse experiences in adolescence
- Exaggerated defense mechanisms
- Avoidant, borderline, histrionic, paranoid, schizoid, and schizotypal PD strongly correlated with comorbid depression
- Comorbidity: major depression, anxiety disorders, substance use disorders, worse outcome
Which is the most severe personality disorder cluster and how are these people perceived?
A-most resistant to treatment
perceived as self-centered, negatively affecting their social relationships
What do individuals with paranoid personality disorders experience?
- sense of being threatened or persecuted
- Others are suspected of intent to harm the individual
- Jealousy and suspicion characterize most relationships
- Individual is isolated, few friends/close relationships
- Argumentative and withdrawn
- Hypercritical of others, respond poorly to any criticism
What is paranoid personality disorder thought to be a milder manifestation of?
characteristics of paranoid schizophrenia
Characteristics of Schizoid Personality Disorder?
- Detachment from social relationships
- Limited expression of emotions in interpersonal relationships
- Little interest in sexual experiences
- Lack of pleasure in activities
- Emotional coldness, detachment or flattened affect
What may Schizoid Personality Disorder be related to?
- May be a spectrum disorder with schizophrenia
- May be related to early attachment difficulties
What is Schizotypal Personality Disorder defined by?
- Schizoid plus the following distorted thinking and behavior:
- Fear & anxiety with relationship
- Cognitive distortions, eccentric behavior, peculiar perceptual experiences, odd thinking and speech, paranoia
- Flat affect; social isolation
- Psychological defense mechanisms associated with schizotypal personality disorder include passive-aggression, devaluation, rationalization, isolation, splitting
What is Cluster B of personality disorders characterized by?
- emotional instability
- disruptive and erratic interpersonal relationships
- restricted affect
- lack of empathy and insight
What is Cluster B personality disorder thought to be a result of?
- deficient or abusive parenting that results in emotional dysregulation
- Evidence for an inherited component for these disorders
What is the criteria for antisocial personality disorder?
Disregard for the rights of others (usually violent behavior) for at least three years in an individual at least 18 years old
Prior to 18 years old, what would a person presenting with symptoms of antisocial personality disorder be diagnosed with?
a conduct disorder
What are signs and symptoms of antisocial personality disorder?
- Failure to conform to lawful behavior; deceitfulness
- Impulsivity, aggressiveness, failure to plan ahead
- Irresponsibility, disregard for the safety of others
- Lack of remorse
- Splitting, denial, projection, acting out
- High risk in legal activities; money problem
What diagnosis (diagnoses) must be ruled out before a diagnosis of antisocial personality disorder?
Bipolar-Manic must be ruled out
What are the signs and symptoms of borderline personality disorder?
- Unstable interpersonal relationships- characterized by alternating idealization and devaluation
- Self-image problems characterized by uncertainty about sexual orientation, long-term goals, or values
- Inappropriate affect- anger; Impulsivity
- Efforts to avoid abandonment
- Suicidal or self-harm behavior
What diagnosis (diagnoses) must be ruled out before a diagnosis of borderline personality disorder?
Depression
bipolar disorder
other personality disorders
What are frequent commodities of borderline personality disorder?
Depression
PTSD
substance abuse
What is Cluster C of personality disorders characterized by?
- anxiety and fear
- Avoidant PD, Dependent PD, Obsessive-compulsive PD
What is the most common Cluster C disorder?
Obsessive-compulsive personality disorder
What are Cluster C disorders as a group highly correlated with?
major depressive disorder and the anxiety disorders
What do theories for the development of Cluster C disorders include?
speculation about attachment difficulties, traumatic life events, and psychological stress and dysfunction
What is the diagnostic criteria for Avoidant Personality Disorder?
- Social inhibition
- Feelings of inadequacy and sensitivity leading to avoidance of activities that require social interaction, restraint in intimate relationships
- Fear of criticism or rejection
- Self-perception of social inadequacy
- Avoid interaction, and often experience significant loneliness
What is the diagnostic criteria for dependent personality disorder?
- Excessive need to be taken care of resulting in submissive and clinging behavior and fear of separation
- Difficulty making independent decisions; excessive need for reassurance; unwillingness to assume responsibility
- Difficulty expressing differences of opinion, and a feeling of helplessness when alone
- May have deficits at certain skills
- More likely to experience physical illness and to make use of the health care system than is true for the general population
What is the diagnostic criteria for obsessive-compulsive personality?
- Preoccupation with order and perfectionism
- Lack of flexibility and preoccupation with details
- Rigidity and stubbornness
- Task completion is problematic due to spending too much time in details
- Decision making is difficult- unable to evaluate choices and act
- Judgmental and moralistic- have difficulty expressing warmth
- Difficulty forming warm relationships
- Mild form in the OCD spectrum
What is the prognosis for personality disorders?
-Behaviors associated with them tend to be fairly ingrained and pervasive—ways of being in the world as opposed to discrete symptoms
Individuals often externalize their problems, blaming others when life does not go as they wish
-Some evidence that individuals with personality disorders can change
Underlying issues for all personality disorders implicating for OT?
- Inaccurate perceptions of self and others
- Inadequate social skills
- Poorly developed personal values and goals
- Poor self-esteem
What kind of group/cooperative activities may be helpful for those with PD?
- Planning a social event; Social skills training
- Interpreting accurately what others say and developing empathy; consistent, clear, and nonjudgmental feedback from the therapist and from other group members may assist in accomplishing this goal
- Must learn to make an active effort to show regard for or understanding of the feelings of others
What are the implications for OT for each cluster of PD?
- Cluster A: sensory integrative interventions
- Cluster B: behavioral approaches
- Cluster C: social skills training
What are the implications for OT in terms of occupational engagement for those with PD?
- Tendency to choose socially disapproved occupation to cope
- Sports- serve as an outlet- nothing to do with social
- Self-care/ meal preparation- meaningless, tedious, seek approval
- Avoid social interaction at workplace
What are the lifespan considerations for those with PD?
- Personality disorders tend to emerge in adolescence
- Need to differentiate from normal adolescent behavior
- B/b these are persistent disorders, often seen in older adults, although symptoms of may lessen over time (notably antisocial PD)
What are some interventions an OT may use for someone with a PD?
- Opportunities for realistic self-appraisal through occupation
- Opportunities to build self-esteem
- Behavior modification
