Personality Disorders - Exam 3 Flashcards
What are Cluster A disorder? B? C?
A:
Paranoid
Schizoid
Schizotypal
B:
Antisocial
Borderline
Histrionic
Narcissistic
C:
Avoidant
Dependent
Obsessive - compulsive
Personality is an enduring patterns of _____, relating to, and thinking about the _______ and oneself
perceiving
environment
Personality Disorders are personality traits are ______ and _____ enough to cause significant distress and impairment of functioning
inflexible
maladaptive
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%
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
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
What is important to remember about pts with personality disorders?
**Believe their own behavior is appropriate
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
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
Which cluster often test and push limits, power struggles, and need to use caution due to manipulation?
Cluster B: borderline, narcissistic, antisocial, histrionic
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
_______ suspicious; overly sensitive; mistrustful; secretive; hyperalert
_______ shy; introverted; withdrawn; avoids close relationships
______ superstitious; socially isolated; suspicious; eccentric behaviors and speech
paranoid
schizoid
schizotypal
Which personality disorder is associated with parents who had irrational outbursts of anger? Men or women?
paranoid personality
MC in women, and psych inpatients
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
What is the tx for paranoid personality disorder?
little data
can try low dose antipsychotics
therapy
Prognosis:
more adaptive capacity
Under stress - withdraw, avoid attachments
Can become overtly psychotic
aka can adapt but can detach socially
Paranoid personality disorder
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
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
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
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
Likely genetic link to schizophrenia
much MC in relatives of schizophrenic pts
MC in men or women?
Schizotypal Personality Disorder
men
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
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
Prognosis:
Anywhere from 10-25% progress to schizophrenia
Poor prognosis associated with paranoid ideation, social isolation, magical thinking, functional decline
Schizotypal Personality Disorder
______ 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
