Personality Disorders - Exam 3 Flashcards by Johannah Crumpton

What are Cluster A disorder? B? C?

A:
Paranoid
Schizoid
Schizotypal

B:
Antisocial
Borderline
Histrionic
Narcissistic

C:
Avoidant
Dependent
Obsessive - compulsive

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Personality is an enduring patterns of _____, relating to, and thinking about the _______ and oneself

perceiving

environment

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Personality Disorders are personality traits are ______ and _____ enough to cause significant distress and impairment of functioning

inflexible

maladaptive

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What are the subgroups of people that are very prone to having a personality disorder?

Psychiatric patients - 50%
Criminals - up to 85%
Alcohol-dependent patients - up to 70%
Drug-dependent patients- up to 90%

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Name some types of personality disorder comorbidities, what is the effect on the outcome?

fighting
suicide attempts
unplanned pregnancies
high risk sexual behavior
anxiety
substance ave
lacking self care
noncompliance with treatment

↑ risk of many comorbidities and negative outcomes

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What are the 2 screening tools used in personality disorders? Give some additional details about each

Minnesota Multiphasic Personality Inventory-2 Restructured Form
(MMPI-2-RF)-> used to dx any mental disorder but does help with personality disorders

**Millon Clinical Multiaxial Inventory-III (MCMI-III) -> focuses on personality style and patterns

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What is important to remember about pts with personality disorders?

**Believe their own behavior is appropriate

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Pts with personality disorders tend to have ??? relationship with rx?

greater sensitivity to SE

take more of the drug than prescribed

be more likely to take alt treatments

higher risk for illicit substance use and alcohol

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Which cluster tend to NOT seek tx, high levels of mistrust, need strong affirmation and careful handing to help built rapport?

Cluster A: schizotypal, schizoid, paranoid

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Which cluster often test and push limits, power struggles, and need to use caution due to manipulation?

Cluster B: borderline, narcissistic, antisocial, histrionic

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Which cluster is more likely to take responsibility, readily engage in dialogue and can be sensitive and stubborn and need frequent affirmation?

Cluster C: dependent, avoidant, obsessive-compulsive

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_______ suspicious; overly sensitive; mistrustful; secretive; hyperalert

_______ shy; introverted; withdrawn; avoids close relationships

______ superstitious; socially isolated; suspicious; eccentric behaviors and speech

paranoid

schizoid

schizotypal

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Which personality disorder is associated with parents who had irrational outbursts of anger? Men or women?

paranoid personality

MC in women, and psych inpatients

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Generalized distrust or suspiciousness
motives are interpreted as malevolent
Feel they have been treated unfairly
Project blame to others
Hold long-lasting grudges
Read hidden meaning into benign remarks or events
Preoccupied with doubts
Often no successful intimate relationships
High autonomy - hostile to those who they think are trying to control them, sometimes to the point of violence

What am I?
What will they present like on PE?

Paranoid Personality Disorder

formal, businesslike, skeptical, mistrustful, poor eye contact or fixated eye contact

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What is the tx for paranoid personality disorder?

little data

can try low dose antipsychotics

therapy

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Prognosis:
more adaptive capacity
Under stress - withdraw, avoid attachments
Can become overtly psychotic

aka can adapt but can detach socially

Paranoid personality disorder

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Possible genetic predisposition
Pregnancy during famine may be a risk factor
May be related to environment devoid of nurturing
May be related to autism

Which personality disorder?
MC in women or men?

Schizoid Personality Disorder
men

Schizoids avoid

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Detachment from relationships, introversion, and restricted range of emotional expression
**does NOT always cause distress
Does not desire or enjoy close relationships
Preference for solitary
Few to no intimate relationships
Intact reality testing but often impaired interpretation of social interactions

What am I?
What will it present like on PE?

Schizoid Personality Disorder

**formal, stiff, aloof, difficult to engage, no obvious desire to get to know others, impaired social skills

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What is the tx for Schizoid Personality Disorder?

little data to support meds

can try antidepressants

therapy: but pts do not feel in distress and do NOT want to interact with others so often do not go and do not fee like therapy is neccessary

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prognosis:
Pts often have social detachment
Less likely to have anxiety/depression than most personality disorders
Avoiding situations that tax their social skills can help

Schizoid Personality Disorder

bland quality, no emotions, relatively indifferent, disconnected, very detached

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Likely genetic link to schizophrenia
much MC in relatives of schizophrenic pts

MC in men or women?

Schizotypal Personality Disorder

men

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Peculiar thoughts
speech and behavior
magical beliefs
social difficulties
negative or poor rapport
social isolation
**No delusions or hallucinations; may experience illusions
Fascinated by unusual ideas

What am I?
What will it present like on PE?

Schizotypal Personality Disorder

inappropriate or constricted affect, odd beliefs, odd speech mannerisms, often go off on tangents

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What is the tx for Schizotypal Personality Disorder?

may try low-dose antipsychotics
Mood stabilizers such as lithium may also be useful

slow introduction into group therapy

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Prognosis:
Anywhere from 10-25% progress to schizophrenia
Poor prognosis associated with paranoid ideation, social isolation, magical thinking, functional decline

Schizotypal Personality Disorder

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______ Dependent; demanding; unstable relationships, self image, and affect; impulsive, micropsychosis _____ Manipulative; selfish; lacks empathy; explosive anger; legal problems _____ dramatic; attention seeking; emotional; superficial ______ self-important; arrogant; grandiose; needs admiration; lacks empathy

borderline antisocial histrionic narcissistic

Antisocial personality is more common in _____ and _______. MC in men or women? Are comorbidities common?

Prisoners and alcoholic men YES!: mood, anxiety and substance use disorders, ADHD, pathological gambling, learning disabilities, and other personality disorders

Often see abusive or absent parents, or parents with poor parenting skills Erratic or inappropriate discipline, inadequate supervision Low socioeconomic status What am I? Is there a genetic component to it?

Antisocial Personality Disorder Likely genetic and environmental: 5X MC among first degree relatives

recurrent disregard for and violation of the rights and feelings of others begins in early childhood poor job performance marital instability, short lived relationships common to see illegal substances easily bored and impulsive exploit others for personal benefit What am I? What do they present like on exam?

antisocial personality disorder manipulative, can attempt to be charming, lack of empathy or remorse for actions, untrustworthy, difficult

What is antisocial personality disorder associated with in children? What are some characteristics as these pts progress into adulthood?

conduct disorder in children Poor job performance Pathological lying and the use of aliases Sexual activity and promiscuity at a younger age than their peers Unstable marriages - may see abuse, separation and/or divorce

What is the tx for antisocial personality disorder?

little data for rx (no meds are usually helpful) **Group Therapy - socially based interventions with others of similar temperaments and problems are tx of choice

Most treatment-refractory personality disorder Behavioral problems peak in late adolescence-early adulthood 30-40% show significant improvement by mid-30s and 40s Tendency toward chronic alcoholism and late-onset depression

Antisocial Personality Disorder lack of remorse not able to function in society

⅓ or more of personality disorder pts May be more common in Hispanic patients Up to 80% attempt suicide; 8-12% succeed High drug abuse rate What am I? MC in women or men?

borderline MC in women aka need other people to help them feel better

Often see history of childhood trauma (sexual or physical) Other parental neglect, poor parental emotional interactions, and overindulgence of child may be associated What am I? Is genetics a factor?

Borderline Personality Disorder YES! due to genetics and environment

impaired relatedness with others (“stormy relationships”) labile mood impulsivity self-injurious behavior poor self-image Intense, unstable relationships Strongly resistant to partner leaving Often interpret neutral events, words, or expressions as negative Repeated and marked mood changes throughout the day impulsive suicide emptiness Self-injurious behavior - cutting, burning - especially if hx of sexual abuse poor self-esteem substance abuse other psych disorders common occassional psychotic decompensation What am I? What will they present like on exam?

Borderline Personality Disorder labile mood, difficult, dependent, demanding, may feel irrational attachment or fear abandonment

What is the tx for borderline personality disorder?

rx have been tried including: Lithium, carbamazepine, antipsychotics, SSRIs group/family and individual therapy

Self-destructive behavior can be lethal if it progresses Patients sometimes will “sabotage” treatment that is going well impulsive/dangerous behaviors declined in middle age What am i?

borderline personality disorders

What are poor prognosis factors for borderline personality disorders? Good prognosis factors?

Poor: antisocial behaviors, chronic anger, over-involvement in family relations, overuse of medical facilities good: higher intelligence, better self-discipline, superior social supports

Histrionic personality disorder is MC in _______. Are they likely to seek treatment? What other personality disorder is it associated with? What was their childhood like?

MC in women likely to seek tx!! associated with antisocial pd Problematic parent-child relationships may contribute

excessive, superficial emotionality and sexuality draw attention, evade unpleasant responsibilities control toher center of attention May become disappointed or sulk if something draws attention away labile moods concerns with their physical appearance seductive, flirtatious Enjoy superficial qualities of relationships but often have trouble in long term relationships What am I? What will they act like on PE?

Histrionic pd may act inappropriately seductive, demands attention, can become quickly **dependent on provider**; seeks instant gratification

What is the tx for histrionic pd?

little evidence that rx is helpful, (MAOIs may be helpful) Need to tx cormorbid anxiety/depression (SSRIs) group therapy, couples therapy and individual therapy

Fairly good; patients tend to improve over time regardless of treatment Can become depressed if they feel abandoned, but often short-lived Poorer prognosis if they meet criteria for other _______

histrionic pd cluster B disorders but can adapt socially

Theorized that parents do not show clear appreciation of a child’s accomplishments May also be linked to excessive attention and over-gratification concerning a child’s accomplishments What am I? MC in men or women?

Narcissistic Personality Disorder MC in men

Grandiosity notable lack of empathy lack of consideration for others sense of entitlement Hypersensitivity to criticism and evaluation Feel as if they deserve special treatment Frequently boastful May be superficially charming Self absorbed - often struggle with commitment Prone to externalize their problems Often vain of their appearance and struggle with aging Can become depressed and withdraw if their self-image is damaged What am I? What does it present like on PE?

Narcissistic Personality Disorder “spoiled” or entitled, selfish, respond poorly to criticism, often do not accept blame, desire admiration and attention

What is the tx for Narcissistic Personality Disorder?

little data that rx is helpful rx for comorbid: depression/anxiety group therapy is helpful unless the group starts criticizing them couples therapy: therapist must not blame everything on them individual: difficult; often have high expectations of therapist and respond poorly to criticism and being confronted with their behavior

Symptoms often do not improve over time without treatment Depression common in middle-aged and older patients What am I?

Narcissistic Personality Disorder

_____ anxious; fears rejection; overly sensitive; poor social skills _____: clinging; submissive; self-sacrificing; needs to be taken care of; passive _____ preoccupied with orderliness, perfectionist, need for control

Avoidant Dependent Obsessive-compulsive

Persistent pattern of _____ due to anxiety restricted lifestyle, and introversion with limited social interactions Introverted, inhibited, anxious individuals Low self-esteem and sensitive to rejection Awkward and uncomfortable in social situations Anxious discussing problem Fears of rejection tend to have a passive role What am I? What does it present like?

avoidant pd restrained, anxious, shy, respond poorly to criticism

May be in part due to “stagnation” when going through the normal developmental stage of shyness and fear of strangers Young people often outgrow social awkwardness - caution when diagnosing in children and adolescents What am I? MC in men or women?

avoidant personality disorder Women- MC

What is the tx for avoidant pd?

SSRIs, MAOIs and beta blockers can all be useful to help with symptoms of anxiety, buspirone and BZDs smaller group therapy and individual therapy

Pts can often adapt to their problems and show little impairment in a favorable environment Social ineptitude and feelings of inadequacy often persist Worse prognosis - other personality disorders, poor environment

Avoidant Personality Disorder

Need to avoid prescribing beta blockers for avoidant pd with ______.

asthma

May be related to childhood environment where dependent behaviors were rewarded and independent activities discouraged Possible genetic influence What am I? MC in men or women? Do they seek tx?

Dependent Personality Disorder women high proportion in clinical setting, will seek tx!

Lifelong interpersonal submissiveness Poor self-esteem Rely heavily on others to get their needs met Strong fear of abandonment Lack of self confidence, difficult to do things alone Often seek to be in a new relationship as soon as an old one ends Often have difficulty making decisions alone Will outwardly agree with others when they really do not What am I? What does it present like on PE?

Dependent Personality Disorder often engage easily but withhold personal information for fear of alienating the provider; seek input from others aka not going to speak out, will agree anyway, not moody about being clingy, passive

What is the tx for Dependent pd?

**SSRIs** or TCAs can help treat associated fatigue, malaise and anxiety, as well as in times of separation **Group - considerable benefit; gives them confidence

Generally good prognosis, especially if no other comorbid diagnoses More capacity for empathy and trust than other disorders

dependent pd

Possibly related to overly controlling parenting Possible stagnation in “anal stages” of development Genetics - more common in first degree relatives What am I? MC in men or women? Why is it a problem?

Obsessive-Compulsive Personality Disorder men Patients often see their own traits as desirable

Rigidity constricted affect inflexibility stubbornness need for orderliness and control Perfectionism do not like to compromise or submit Occupational difficulty - often refuse to work with others Often frugal: do not like to throw away worthless objects devoted to work to the exclusion of leisure activities May display preoccupation with lists, organization, schedules What am I? What do they present like on PE?

Obsessive-Compulsive Personality Disorder can seem inflexible and high-strung, perfectionist, formal, stiff, self-conscious, desire to be a “good patient” aka very controlling and high functioning

What is the difference between Obsessive-Compulsive Personality Disorder and Obsessive-Compulsive Disorder?

OCPD pt: NO true obsessions or compulsions little to no distress from the behaviors less time spent in obsessive-like tasks than OCD pts

What is the tx for Obsessive-Compulsive Personality Disorder?

no little data for rx SSRIs may help lessen perfectionism and associated anxiety/depression therapy is NOT helpful because the pt does NOT feel distressed about the behaviors, often highly critical of self or therapy

Generally good prognosis, especially if no other comorbid diagnoses Self-discipline and organization help preclude complications Are prone to developing anxiety and depression

Obsessive-Compulsive Personality Disorder