Personality Disorders (CH 6) Flashcards
Personality
one’s set of stable, predictable, emotional, and behavioral traits
Personality disorder
enduring patterns of inner experience and behavior that deviate markedly from expectations of an individual’s culture.
They are pervasive, maladaptive, cause significant impairment in social or occupational functioning
Often lack insight about their problems
Sxs either ego-syntonic or immutable
pt’s vulnerable to develop sxs of other mental disorders during stress
DSM5 criterial for personality disorder
Enduring pattern of behavior/inner experience that deviates from the person’s culture and is manifested in two or more:
- cognition
- affect
- interpersonal functioning
- impulse control
The pattern:
- pervasive and inflexible in broad range of situations
- Stable, onset adolescence or early adulthood
- leads to significant distress in functioning
Cluster A
Schizoid, schizotypal, paranoid
eccentric, peculiar, withdrawn
Familial association with psychotic disorders
Cluster B
Antisocial, borderline, histrionic, narcissistic
emotional, dramatic, inconsistent
Familial association with mood disorders
Cluster C
avoidant, dependent, obsessive-compulsive
anxious or fearful
familial association with anxiety disorders
Paranoid personality disorder (PPD)
pervasive distrust and suspiciousness of others, often interpret motives as malevolent
blame their own problems on others and seem angry and hostile
pathologically jealous, leads them to think their sexual partners or spouses are cheating on them
Higher incidence in family members of schizophrenics
chronic course, lifelong marital and job problems
Paranoid personality disorder DSM5 criteria
general distrust of others, beginning in early adulthood, present in variety of contexts
At least four:
- suspicion (w/o evidence) that others are exploiting or deceiving him or her
- preoccupation with doubts of loyalty or trustworthiness of friends or acquaintances
- Reluctance to confide in others
- Interpretation of benign remarks as threatening or demeaning
- Persistence of grudges
- Perception of attacks on his or her character not apparent to others, quick to counterattack
- Suspicions regarding fidelity of spouse or partner
Ddx for Paranoid personality disorder
Schizophrenia: PPD do not have any fixed delusions, not frankly psychotic - can have transient psychosis under stress
Social disenfranchisement and social isolation: PPD assisted by assessment of other in close contact, may identify what they consider as excess suspicion
Treatment of Paranoid personality disorder
Psychotherapy treatment of choice
-group avoided d/t mistrust and misinterpretation of other’s statements
short course of antipsychotics for transient psychosis
Schizoid personality disorder
lifelong pattern of withdrawal eccentric and reclusive quiet and unsociable constricted affect No desire for close relationships, prefer to be alone
Schizoid personality disorder DSM5 criteria
voluntary social withdrawal and restricted range of emotional expression beginning early adulthood, present in variety of contexts
Four or more:
- Neither enjoying nor desiring close relationships (including family)
- Generally choosing solitary activities
- Little (if any) interest in sexual activity with another person
- Taking pleasure in few activities (if any)
- Few close friends or confidants (if any)
- Indifference to praise or criticism
- Emotional coldness, detachment, or flattened affect
DDX for Schizoid personality disorder
Schizophrenia: schizoid do not have fixed delusions or hallucinations
Schizotypal personality disorder: Schizoid do not have same eccentric behavior or magical thinking
Treatment for Schizoid personality disorder
Lack insight for individual psychotherapy, group threatening
May benefit from day programs or drop in centers
Antidepressants if comorbid major depression
Schizotypal personality disorder
pervasive pattern of eccentric behavior and peculiar thought patterns
Perceived as strange and odd
Chronic course, small minority -> schizophrenia
Premorbid personality type for a patient with schizophrenia
Schizotypal personality disorder DSM5 criteria
Pattern of social defects marked by eccentric behavior, cognitive or perceptual distortions, discomfort with close relationships, begins early adulthood, present in variety of contexts.
Five or more:
- Ideas of reference (excluding delusions of reference)
- Odd beliefs or magical thinking, inconsistent with cultural norms
- Unusual perceptual experiences (bodily illusions)
- Suspiciousness
- Inappropriate or restricted affect
- Odd or eccentric appearance or behavior
- Few close friends or confidants
- Odd thinking or speech (vague, stereotyped)
- Excessive social anxiety
Magical thinking:
- belief in clairvoyance or telepathy
- bizarre fantasies or preoccupations
- belief in superstitions
Odd behaviors: involved in cults or strange ` practices
DDX for Schizotypal personality disorder
Schizophrenia: schizotypal not frankly psychotic (transiently under stress), no fixed delusions
Schizoid personality disorder: schizoids do not have same eccentric behavior
Treatment of Schizotypal personality disorder
Psychotherapy to help develop social skills training
Short course of low-dose antipsychotics (transient psychosis), Antipsychotics decrease social anxiety and suspicion in interpersonal relationships
Antisocial Personality Disorder
Exploitive of others
Break rules to meet their own needs
Lack empathy, compassion, remorse for actions
Impulsive, deceitful, often violate law
Skilled at reading social cues, appear charming and normal first time meeting
Chronic course, some improvement with age
Multiple somatic complaints, coexistence of substance use disorders and major depression
increased morbidity from substance use, trauma, suicide, or homicide
Antisocial Personality Disorder DSM5 Criteria
Pattern of disregard for and violation of rights of others since age 15
Must be 18 for dx, hx of behavior as child/adolescent consistent with conduct disorder
Three or more:
- Failure to conform to social norms by committing unlawful acts
- Deceitfulness/repeated lying/manipulating others for personal gain
- impulsivity/failure to plan ahead
- Irritability and aggressiveness/repeated fights or assaults
- Recklessness and disregard for safety of self or others
- Irresponsibility/failure to sustain work or honor financial obligations
- Lack of remorse for actions
Treatment of Antisocial Personality Disorder
Psychotherapy generally ineffective
Treat sxs of anxiety or depression, use caution d/t high addictive potential of these patients
Borderline Personality Disorder (BPD)
Unstable moods, behaviors, interpersonal relationships
Fear abandonment, poorly formed identity
Relationships begin with intense attachments, end with slightest conflict
Aggression common
Impulsive, hx of repeated suicide attempts/gestures or episodes of self-mutiliation
Higher rates of childhood physical, emotional, sexual abuse
3x more often women
10% suicide rate
Develop stability in middle age
Coexisting major depression and/or substance abuse
Borderline Personality Disorder (BPD) DSM5 criteria
Pervasive pattern of impulsivity and unstable relationships, affects, self-image, behaviors, present by early adulthood in variety of contexts
at least five:
- frantic efforts to avoid real or imagined abandonment
- unstable, intense interpersonal relationships (extreme love-hate relationships)
- unstable self image
- impulsivity in at least 2 potentially harmful ways (spending, sexual activity, substance use, binge eating)
- recurrent suicidal threats or attempts or self mutilation
- Unstable mood/affect
- Chronic feelings of emptiness
- Difficulty controlling anger
- transient, stress-related paranoid ideation or dissociative symptoms
ddx for Borderline Personality Disorder (BPD)
Schizophrenia: BPD no frank psychosis - transient if decompensate under stress or substance abuse
Bipolar II: BPD mood swings rapid, brief, moment to moment reactions to perceived environmental or psychological triggers
Treatment for Borderline Personality Disorder (BPD)
Dialectical behavior therapy - includes CBT, mindfullness skills, group therapy
Pharmacotherapy to tx psychotic or depressive sxs
Histrionic Personality Disorder (HPD)
exhibit attention-seeking behavior, excessive emotionality
dramatic, flamboyant, extroverted but unable to form long-lasting, meaningful relationships
sexually inappropriate and provocative
Chronic course, improves with age
Defense mechanism: regression
Histrionic Personality Disorder (HPD) DSM5 criteria
Pattern of excessive emotionality and attention seeking - early adulthood
At least five:
- uncomfortable when not the center of attention
- inappropriately seductive or provocative
- Rapidly shifting but shallow expression of emotion
- Uses physical appearance to draw attention to self
- Speech that is impressionistic and lacking in detail
- Theatrical and exaggerated expression of emotion
- Easily influenced by others or situation
- Perceives relationships as more intimate than they actually are
DDX for Histrionic Personality Disorder (HPD)
Borderline personality disorder: BPD more likely to have depression, brief psychotic episodes, attempt suicide. HPD generally more functional
Treatment of Histrionic Personality Disorder (HPD)
Psychotherapy: supportive, problem-solving, interpersonal, group
Tx depressive or anxious sxs
Narcissistic Personality Disorder (NPD)
Sense of superiority, need for admiration, lack of empathy
consider themselves “special”, will exploit others for own gain
fragile self-esteem
Chronic course - high incidence of depression and midlife crisis d/t high value of youth and power
Narcissistic Personality Disorder (NPD) DSM5 criteria
Pattern of grandiosity, need for admiration, lack of empathy beginning early adulthood, present variety of contexts
Five or more:
- exaggerated sense of self-importance
- preoccupation with fantasies of unlimited money, success, brilliance
- Believes he/she is “special” or unique and can associate only with other high-status individuals
- Requires excessive admiration
- has sense of entitlement
- takes advantage of others for self gain
- lacks empathy
- envious of others or believes others are envious of him/her
- arrogant or haughty
DDX for Narcissistic Personality Disorder (NPD)
Antisocial personality disorder: both exploit others, NPD want status and recognition, anti social want material gain or subjugation of others
NPD more depressed they don’t get recognition
Treatment of Narcissistic Personality Disorder (NPD)
Psychotherapy treatment of choice
Antidepressants if comorbid mood disorder
Avoidant personality disorder
pervasive pattern of social inhibition, intense fear of rejection
avoid situations they may be rejected in
fear of rejection so overwhelming, affects all aspects of their lives
avoid social interactions, seek jobs with little interpersonal contact
Desire companionship, but extremely shy, easily injured
Chronic course, remits with age
Difficult during adolescence, increased anxiety, depressive disorders
If support system fails, very susceptible to depression, anxiety, anger
Avoidant personality disorder DSM5 criteria
pattern of social inhibition, hypersensitivity, feelings of inadequacy since early adulthood
At least four:
- avoids occupation involving interpersonal contact d/t fear of criticism and rejection
- unwilling to interact unless certain of being liked
- Cautious of interpersonal relationships
- Preoccupied with being criticized or rejected in social situations
- inhibited in new social situations because he or she feels inadequate
- Believes he or she is socially inept and inferior
- Reluctant to engage in new activities for fear of embarrassment
DDX for Avoidant personality disorder
Schizoid personality disorder: Schizoid doesn’t want companionship, Avoidants do but too shy
Social anxiety disorder: sx before adulthood, personality disorder likely, social is fear of embarrassment in particular setting; avoidant overall fear rejection and sense inadequacy
Dependent personality disorder: avoidant clinic to relationships like dependents; avoidants slow to get involved, dependents are aggressively seeking relationships
Treatment for Avoidant personality disorder
Psychotherapy - assertiveness, social skills training
Group beneficial
SSRIs for comorbid social anxiety disorder or major depression
Dependent Personality Disorder (DPD)
Poor self-confidence, fear of separation
excessive need to be taken care of and allow other to make decisions for them
feel helpless when alone
Regression often seen
Course chronic
Prone to depression - esp after loss of person they are dependent
Difficulties w/ employment, cannot act independently or without close supervision
Dependent Personality Disorder (DPD) DSM5 criteria
Pattern of excessive need to be taken care of -> submissive and clinging behavior
At least five:
- difficulty making everyday decisions without reassurance from others
- needs others to assume responsibilities for most areas of his/her life
- Difficulty expressing disagreement because of fear of loss of approval
- Difficulty initiating projects because of lack of self confidence
- Goes to excessive lengths to obtain support from others
- Feels helpless when alone
- Urgently seeks another relationship when one ends
- Preoccupied with fears of being left to take care of self
DDX for Dependent Personality Disorder (DPD)
Avoidant personality disorder: avoidant clinic to relationships like dependents; avoidants slow to get involved, dependents are aggressively seeking relationships
Borderline and histrionic personality disorders: DPD long lasting relationships with one person they are dependent on, BPD and HPD unable to maintain long lasting relationships
Treatment for Dependent Personality Disorder (DPD)
Psychotherapy - CBT, assertiveness, social skills training treatment of choice
tx sxs of anxiety or depression
Obsessive-Compulsive Personality Disorder (OCPD)
Pervasive pattern of perfectionism, inflexibility, and orderliness
preoccupied with unimportant details -> unable to complete simple tasks in timely fashion
Appear stiff, serious, formal with constricted affect
Successful professionally, poor interpersonal skills
Obsessive-Compulsive Personality Disorder (OCPD) DSM5 criteria
Pattern of preoccupation with orderliness, control, perfectionism at expense of efficiency and flexibility - present early adulthood, in variety of contexts
At least four:
- Preoccupation with details, rules, lists, organization such that major point of activity is lost
- Perfectionism detrimental to completion of task
- Excessive devotion to work
- Excessive conscientiousness and scrupulousness about morals and ethics
- Will not delegate tasks
- Unable to discard worthless objects
- Miserly spending style
- Rigid and stubborn
DDX for Obsessive-Compulsive Personality Disorder (OCPD)
OCD: OCPD do not have recurrent obsessions or compulsions present in OCD; OCPD sxs are ego-syntonic rather than ego-dystonic seen in OCD; OCD aware have problem and wish thoughts/behaviors would go away
Narcissistic personality disorder: NPD motivated by status, OCPD motivated by work itself
Treatment of Obsessive-Compulsive Personality Disorder (OCPD)
CBT useful
tx associated sxs as necessary
