Personality Disorders - Cluster B Flashcards
which personality disorders belong to cluster b? (pneumonic: No Booze After Hours)
Narcissistic
Borderline
Antisocial
Histrionic
what is the hallmark of antisocial personality?
disregard for, and violation of, the rights of others. tend to be aggressive and have no concern for themselves or others. they don’t learn from experience and are unwilling to conform to social norms
whats the difference between antisocial personality and criminality?
illegal behavior is only for gain and not accompanied by rigid personality traits.
what was the childhood like for someone with antisocial personality disorder?
begins in childhood as a conduct order…
as kids they had conflicts with parents, authority figures, peers, etc. stealing, vandalism, fire setting, cruelty to animals/other kids, school-related behavior probs, running away from home, poor academic performance
when is the onset of antisocial personality and how old must you be to achieve the diagnosis?
onset: prior to age 15
must be at least 18 to be diagnosed
what sort of mask do patients with antisocial personality wear to fool clinicians?
mask of sanity
what demographic is antisocial personality seen in?
poor urban areas and in larger families.
~75% of prison population!
scenario: a 29 yo man tells you has stolen valuable items from friends/family on many occasions with no intention of returning them and without concern for the people he stole from. He has been unemployed on and off for many years and has been arrested on a variety of minor charges.
which personality disorder does this describe?
antisocial personality disorder
what is the pneumonic for antisocial personality disorder?
CALLOUS MAN
what does CALLOUS MAN stand for (in antisocial personality)?
CONDUCT disorder before age 15 (current age 18 or older)
ANTISOCIAL acts, commits acts that are grounds for arrest
LIES frequently
LACUNAE lacks superego
OBLIGATIONS not honored
UNSTABLE - can’t plan ahead
SAFETY of self and others ignored
MONEY problems (kids and spouse are not supported)
AGGRESSIVE and assaulted
NOT occurring exclusively during schizophrenia/mania
do patients with antisocial personality have remorse?
no
how many of the DSM criteria are needed to have antisocial personality?
at least 3 out of 7
what are some common comorbids seen in a patient with antisocial personality
ETOH/Drugs, Gambling, ADHD, MDD
what are some contact tips for the patient with antisocial personality?
set firm limits
understand patient’s fear of intimacy
patients often run from real human experiences
which class of drugs are concerning for patients with antisocial personality? which class of drugs are choice for severe aggression for them? which class of drugs is second line treatment?
benzos.
atypical antipsychotics.
SSRI and/or mood stabilizers
why do people with antisocial personality tend to have a premature death?
they commit suicide, get into accidents, or are a victim of homicide
what is the hallmark of borderline personality disorder?
they leave a trail of destruction. pattern of instability in interpersonal relationships, self image, and affects, and marked impulsivity.
emphasis on INSTABILITY
borderline personality… they border between _____ and _____
neurosis and psychosis
describe a mood swing of a patient with borderline personality
argumentative then depressed then complain of no feelings
what are borderline personality patients most afraid of?
abandonment. they constantly search for companionship
what is the defense mechanism of a borderline personality patient?
splitting (love/hate relationships)
scenario: a 39 yo female tells you on her second visit that she is in love with you. when you refer her to another physician, she attempts suicide.
what personality disorder does this describe?
borderline personality disorder
what are the most common sx of borderline personality disorder?
anger
feelings of boredom
emptiness
have a tendency to see others as all good or all bad (splitting)
what does ICD-10 call borderline personality disorder?
emotionally unstable personality disorder
what is the pneumonic for borderline personality disorder?
I RAISED A PAIN
what does the pneumonic I RAISED A PAIN stand for (borderline personality)
IDENTITY disturbance
RELATIONSHIPS unstable
ABANDONMENT frantically avoided (whether real/imagined)
IMPULSIVITY
SUICIDAL gestures (threats, self-mutilation)
EMPTINESS
DISSOCIATIVE sx
AFFECTIVE instability
PARANOID ideation (stress-related and transient)
ANGER poorly controlled
IDEALIZATION followed by devaluation
NEGATIVISTIC (undermine self with self-defeating behavior)
How many of the DSM characteristics does one need to classify as borderline personality disorder?
at least 5 of the 9
why are females more commonly seen with borderline personality disorder in the clinical population?
maybe because they are more likely to seek medical attention over men`
what do first degree relatives of patients with borderline personality disorder commonly have?
substance abuse or MDD
what are common comorbidities seen in borderline personality disorder?
PTSD, eating disorder, substance abuse, antisocial PD, narcissistic PD, schizotypal PD
what is the most widely studied personality disorder?
borderline personality disorder
does borderline personality disorder progress to schizophrenia?
no
what is the hallmark of histrionic personality disorder? do they mellow with age?
excessive emotionality and attention seeking
yes, they mellow with age
what may a patient with histrionic appear like?
colorful, dramatic, extroverted fashion, everything is a catastrophe, attention seeking behavior, seductive (both sexes)
patients with what personality disorder like to be the center of attention?
histrionic personality disorder
scenario: a 25 yo female patient comes to office dressed in low-cut blouse and short skirt and brings a gift for you. she fishes for complements and the office staff tells you that yesterday she “almost bled to death” when she cut her finger.
what personality disorder does this patient have?
histrionic personality disorder
defense mechanisms of repression, regression (revert to childlike behavior), and somatization are characteristic of which personality disorder?
histrionic personality disorder
how many of the 8 DSM criteria must a patient have to classify as histrionic personality?
at least 5 of 8
what is the pneumonic for histrionic personality disorder/
I CRAVE SIN
what does the pneumonic I CRAVE SIN (histrionic) stand for?
INAPPROPRIATE behavior (seductive/provocative) CENTER of attention RELATIONSHIPS seen as closer than they really are APPEARANCE is most important VULNERABLE to others' suggestions EMOTIONAL expression is exaggerated SHIFTING emotions, shallow IMPRESSIONISTIC manner of speaking NOVELTY is craved
what do people with histrionic personality lack insight to?
their true feelings or motivations
what is the hallmark of narcissistic personality disorder?
the world revolves around them.
pattern of grandiosity, need for admiration, lack of empathy. heightened sense of self importance and grandiose feelings of uniqueness
what personality disorder includes patients who consider themselves as special and expect special treatment; sense of entitlement; handle criticism poorly?
narcissistic personality disorder
scenario: a 40 yo male pt tells you that bc you are a doctor, you can understand that he is “better than most people” . . he then asks you to be referred to a physician who graduated from an Ivy League school
what personality disorder does this patient likely have?
narcissistic personality disorder
is psychotherapy helpful for narcissistic personality?
no, because they lack insight into behavior
how many of the DSM criteria are needed to fulfill narcissistic personality?
at least 5 of 9
what is the pneumonic for narcissistic personality?
A FAME GAME
what does the pneumonic A FAME GAME (narcissistic) stand for?
ADMIRATION required in high amounts FANTASIZES about unlimited success ARROGANT MANIPULATIVE ENVIOUS of others GRANDIOSE sense of importance ASSOCIATES with special people ME first attitude EMPATHY lacking for others
