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Behavioral Dynamics > Personality Disorders - Exam 3 > Flashcards

Personality Disorders - Exam 3 Flashcards

1
Q

What are Cluster A disorder? B? C?

A

A:
Paranoid
Schizoid
Schizotypal

B:
Antisocial
Borderline
Histrionic
Narcissistic

C:
Avoidant
Dependent
Obsessive - compulsive

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2
Q

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

A

perceiving

environment

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3
Q

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

A

inflexible

maladaptive

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4
Q

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

A

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

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5
Q

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

A

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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6
Q

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

A

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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7
Q

What is important to remember about pts with personality disorders?

A

**Believe their own behavior is appropriate

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8
Q

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

A

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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9
Q

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

A

Cluster A: schizotypal, schizoid, paranoid

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10
Q

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

A

Cluster B: borderline, narcissistic, antisocial, histrionic

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11
Q

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

A

Cluster C: dependent, avoidant, obsessive-compulsive

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12
Q

_______ suspicious; overly sensitive; mistrustful; secretive; hyperalert

_______ shy; introverted; withdrawn; avoids close relationships

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

A

paranoid

schizoid

schizotypal

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13
Q

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

A

paranoid personality

MC in women, and psych inpatients

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14
Q

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?

A

Paranoid Personality Disorder

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

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15
Q

What is the tx for paranoid personality disorder?

A

little data

can try low dose antipsychotics

therapy

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16
Q

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

aka can adapt but can detach socially

A

Paranoid personality disorder

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17
Q

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?

A

Schizoid Personality Disorder
men

Schizoids avoid

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18
Q

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?

A

Schizoid Personality Disorder

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

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19
Q

What is the tx for Schizoid Personality Disorder?

A

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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20
Q

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

A

Schizoid Personality Disorder

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

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21
Q

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

MC in men or women?

A

Schizotypal Personality Disorder

men

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22
Q

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?

A

Schizotypal Personality Disorder

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

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23
Q

What is the tx for Schizotypal Personality Disorder?

A

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

slow introduction into group therapy

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24
Q

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

A

Schizotypal Personality Disorder

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25
Q

______ 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

A

borderline

antisocial

histrionic

narcissistic

26
Q

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

A

Prisoners and alcoholic

men

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

27
Q

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?

A

Antisocial Personality Disorder

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

28
Q

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?

A

antisocial personality disorder

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

29
Q

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

A

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

30
Q

What is the tx for antisocial personality disorder?

A

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

31
Q

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

A

Antisocial Personality Disorder

lack of remorse
not able to function in society

32
Q

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?

A

borderline

MC in women

aka need other people to help them feel better

33
Q

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?

A

Borderline Personality Disorder

YES! due to genetics and environment

34
Q

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?

A

Borderline Personality Disorder

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

35
Q

What is the tx for borderline personality disorder?

A

rx have been tried including: Lithium, carbamazepine, antipsychotics, SSRIs

group/family and individual therapy

36
Q

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?

A

borderline personality disorders

37
Q

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

A

Poor: antisocial behaviors, chronic anger,
over-involvement in family relations, overuse of medical facilities

good: higher intelligence, better self-discipline, superior social supports

38
Q

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?

A

MC in women

likely to seek tx!!

associated with antisocial pd

Problematic parent-child relationships may contribute

39
Q

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?

A

Histrionic pd

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

40
Q

What is the tx for histrionic pd?

A

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

group therapy, couples therapy and individual therapy

41
Q

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 _______

A

histrionic pd

cluster B disorders

but can adapt socially

42
Q

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?

A

Narcissistic Personality Disorder

MC in men

43
Q

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?

A

Narcissistic Personality Disorder

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

44
Q

What is the tx for Narcissistic Personality Disorder?

A

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

45
Q

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

What am I?

A

Narcissistic Personality Disorder

46
Q

_____ 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

A

Avoidant

Dependent

Obsessive-compulsive

47
Q

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?

A

avoidant pd

restrained, anxious, shy, respond poorly to criticism

48
Q

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?

A

avoidant personality disorder

Women- MC

49
Q

What is the tx for avoidant pd?

A

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

smaller group therapy and individual therapy

50
Q

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

A

Avoidant Personality Disorder

51
Q

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

A

asthma

52
Q

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?

A

Dependent Personality Disorder

women

high proportion in clinical setting, will seek tx!

53
Q

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?

A

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

54
Q

What is the tx for Dependent pd?

A

SSRIs or TCAs can help treat associated fatigue, malaise and anxiety, as well as in times of separation

**Group - considerable benefit; gives them confidence

55
Q

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

A

dependent pd

56
Q

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?

A

Obsessive-Compulsive Personality Disorder

men

Patients often see their own traits as desirable

57
Q

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?

A

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

58
Q

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

A

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

59
Q

What is the tx for Obsessive-Compulsive Personality Disorder?

A

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

60
Q

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

A

Obsessive-Compulsive Personality Disorder

61
Q
A

Behavioral Dynamics (16 decks)

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