Personality Disorders - Hill Flashcards
inflexible, maladaptive, and rigidly pervasive pattern of behavior causing subjective distress and/or impaired functioning
- person usually not aware of the problem
- usually presents by early adulthood
personality disorder
A. enduring pattern on inner experience and behavior that deviates markedly from the expectations of the individuals culture. this pattern manifests in 2+ of the following”
- cognition (perception/interpretation of self, others and events)
- affect (range/intensity/liability/appropriateness of emotional response
- interpersona functioning
- impulse control
B. enduring pattern is inflexible and pervasive across a broad range of personal and social situations
C. enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning
D. pattern is stable and of long duration, onset can be traced back to adolescence/early childhood
personality disorder
NOTE: people under age 18 who fit the criteria are usually not dx, although they may be dx with a related disorder
- in order to dx someone under 18 with a personality disorder, symptoms MUST be present for AT LEAST 1 YEAR (but general rule of thumb is that diagnosis shouldn’t be made until person is at least 18
- antisocial PD canNOT, by definition, be diagnosed at all in person under 18
What is included in the Cluster A Category of PD?
“weird” - odd or eccentric disorders:
- paranoid PD
- schizoid PD
- schizotypal PD
irrational suspicions and mistrust of others
- others exploit/deceive the person
- friends/associated are untrustworthy
- information confided to others will be used maliciously
- there is hidden meaning in remarks
- spouse in unfaithful
- risk for agoraphobia, major depression, OCD and substance abuse
paranoid PD
lack of interest in social relationships, seeing no point in sharing time with others
- appear indifferent to the praise/criticism of others and often seem cold or aloof
- marked by little pleasure in acitivites
- lacks close friends or confidants other than first-degree relatives
schizoid PD
- true loners
characterized by odd behavior or thinking
- ideas of reference (believing public messages are directed personally at them)
- odd beliefs or magical thinking
- vague, circumstantial, or stereotyped speech
- excessive social anxiety that does not diminish with familiarity
- idiosyncratic perceptual experiences or bodily illusion
schizotypal PD
- loner with weird beliefs of the world
what is included in the Cluster B Category for PD?
dramatic, emotional or erratic disorders:
- antisocial PD
- borderline PD
- histrionic PD
- narcissistic PD
pervasive disregard for the law and rights of others
- repeated violations of the law
- lying and deception
- physical aggressiveness
- reckless disregard for safety of self or others
- consistent irresponsibility in work and family environments
- lack of remorse
antisocial PD
- sociopaths, psychopaths (the joker, house of cards)
- 3x more prevalent in men than women
- has a genetic basis
- often at risk for: anxiety disorders, substance abuse, somatization disorder, pathological gambling
NOTE: most effective tx is to keep away from society!
“black and white” thinking
- instability in relationships, self-image, identity and behavior
- frantic efforts to avoid expected abandonment
- unstable/intense interpersonal relationships
- markedly persistent unstable self-image
- impulsivity (sex, substance abuse, reckless driving)
- recurrent suicidal behaviors or threats, or self-mutilation
- affective instability
- chronic feelings of emptiness
- inappropriate and intense anger
- transient paranoia or dissociation
borderline PD
- 3x more common in women
- very manipulative by nature
- immature traits: teddy bear and tweety bird signs
- need to set rigid boundaries when treating
- are often victims of sexual abuse or emotional abuse
- high rate of comorbid major depression
pervasive attention-seeking behavior including inappropriate sexual seductiveness and shallow or exaggerated emotions
- quite dramatic and often sexually provocative
- emotionally liable
- “la belle indifference”: seemingly indifferent detachment, while describing dramatic physical sx
- associated with somatoform disorders
histrionic PD (cardi B, other celebrities)
pervasive pattern of grandiosity, need for admiration, and lack of empathy
- exaggeration of their own talents/accomplishments
- sense of entitlement
- exploitation of others
- lack of empathy
- envy of others
- arrogant, haughty attitude
- 50-75% are male
narcissistic PD (donald trump)
at risk for:
- anorexia nervosa
- substance abuse
- depression
what are included in the Cluster C category of PD?
anxious or fearful disorders
- avoidant PD
- dependent PD
- OCPD
social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation and avoidance of social interaction
- differs from pt with schizoid in the desire to have relationships with others
- paralyzed by their fear and sensitivity into social isolation
- shy, but not as odd as Cluster A types
avoidant PD (michael jackson)
pervasive psychological dependence on other people
- difficult making decisions without guidance/reassurance
- need for others to assume responsibility for most major areas of the person’s life
- difficult expressing disagreement with others
- difficulty initiating activities because of lack of confidence
- excessive measures to obtain nurturance and support
- discomfort/helplessness when alone
- urgent seeking for another relationship when one has ended
- unrealistic preoccupation with fears of being left to fend for themselves
dependent PD
rigid conformity to rules, moral codes and excessive orderliness
- marked preoccupation with perfectionism and control
- lack of flexibility/openness
- preoccupations interfere with efficiency despite their focus on tasks
- often scrupulous and inflexible about matters of morality, ethics, and values to a point beyond cultural norms
- often stingy as well as stubborn
OCPD
- dx 2x more often in men
presence of two or more distinct identities or personality states
- disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition
- more common in women
- assoc w/hx of sexual abuse
dissociative identity disorder (aka multiple personality disorder)
what type of therapy:
- examines the ways that pts perceive events
- assumption that perceptions are shaped by early life
- identify perceptual distortions and their historical sources
- facilitate the development of more adaptive modes of perceptions and response
- frequency from several times a week to once a month
psychodynamic psychotherapy
what type of therapy:
- deals with how people think about their world and their perception of if
- typically limited to episodes of 6-20 weeks, once weekly
cognitive behavior therapy (CBT)
what type of therapy:
- allows interpersonal psychopathology to display itself among peer patients
- usually once weekly over a course that may range from several months to years
group psychotherapy
what type of therapy:
- skills-based therapy developed by Marsha Linehan, PhD
- both individual and group formats
- applied to BORDERLINE PD know this!
- manual-based therapy is on the developemnt of coping skills to improve affective stability and impulse control and on reducing self-harmful behavior
- also being used with other cluster B personality disorders to reduce impulsive behavior
dialectical behavior therapy (DBT)
why are medications used in PD even though not curative for any PD disorder?
used as an adjunct to psychotherapy so that the patient may productively engage in psychotherapy
- tx of symptoms clusters such as cognitive-perceptual symptoms, affective dysregulation, and impulsive-behavioral dyscontrol
what meds are used to treat PD?
SSRIs and newer antidepressants are safe and reasonably effective
what meds are usually NOT prescribed to treat PD?
TCA’s and MAOI’s
NOTE: benzo’s narcotics and other drugs with addictive potential should be used with caution
what anticonvulstant can help with impulse control in PD?
valproic acid
when is homicide particularly considered a complication?
antisocial and paranoid PD’s
which Cluster has the worst prognosis?
cluster B
- susceptible to problems of substance abuse
- impulse control, and suicidal behavior, which may shorter their lives
which cluster tends to become less severe and intense in middle age and late life?
cluster A and B
which cluster tends to become exaggerated in later life?
cluster C
