Personality Disorders II

Question 1

describe avoidant personality disorder

Answer 1

• example symptoms
  
  • avoids interpersonal and occupational activities for fear of criticism
  • unwilling to start relationship unless certain of being liked
  • restraint within relationship for fear of ridicule
  • reluctance to engage in new activities
  • negative self-image
• theme: inferiority complex

Question 2

describe differentials from avoidant personality disorder

Answer 2

• schizoid personality disorder (SPD):
  
  • people with schizoid personality have no desire for a relationship; those with avoidant personality desire a relationship
• social anxiety disorder (SAD):
  
  • an anxiety disorder characterized by excessive fear of negative evaluations
  • SAD patients have higher amounts of sympathetic nervous system arousal
  • avoidants have some anxiety but not the extreme levels seen in SAD

Question 3

describe dependent personality disorder

Answer 3

• example symptoms:
  
  • indecisive
  • others must take responsibility for life
  • difficulty disagreeing
  • difficulty initiating due to low confidence
  • excessive lengths to keep/gain support
  • feels helplesss when alone
  • urgently seeks another relationship if one ends
• theme: excessive need to be cared for

Question 4

describe obsessive-compulsive personality disorder (OCPD)

Answer 4

• example symptoms:
  
  • preoccupation with details, rules, lists until point of activity is lost
  • perfectionism interferes with task completion
  • excessive devotion to work
  • rigid and stubborn
  • over conscientious, scrupulous
  • reluctance to delegate or to work with others
  • hoarding and miserly behavior
• theme: inflexible perfectionism and control

Question 5

contrast OCPD and OCD

Answer 5

• OCD (obsessive-compulsive disorder) involves uncontrolled intrusive thoughts and repeated rituals
• OCPD is characterized by excessive perfectionism and control, similar to the “Type A” personality
  
  • characteristics: competitive, time urgent, pressured, impatient, irritable, hostile
  • association: coronary heart disease

Question 6

describe common features of disruptive, impulse-control and conduct disorders

Answer 6

• common features of these disorders:
  
  • problems with the self-control of emotions and behaviors
  • self-control problems violate the rights of others and/or bring the individual into conflict with societal norms or authority figures
  • symptoms of these disorders can occur to a lesser degress in normally developing individuals
    
    • oppositional behavior

Question 7

describe diagnostic criteria for oppositional defiant disorder (ODD)

Answer 7

• behaviors/emotions characterized by:
  
  • angry/irritable mood
    
    • often loses temper, easily annoyed, resentful
  • argumentative/defiant behavior
    
    • often argues/refuses to comply with authority, deliberately annoys, blames
  • vindictiveness
• behaviors do NOT result in a serious violation of the rights of others

Question 8

describe diagnostic criteria for conduct disorder

Answer 8

• repeated and persistent serious violation of rights/societal norms
• multiple symptoms occuring in or across any of the categories:
  
  • aggressive conduct
  • deliberate property destruction
  • deceit or theft
  • serious violation of rules

Question 9

describe the subtypes of conduct disorder (CD)

Answer 9

• childhood-onset type (<10 yrs)
  
  • usually boys
  • characterized by aggressive conduct
  • often have a history of ODD and are at higher risk of ASPD
• adolescent-onset type (>10 yrs)
  
  • less of a bias towards boys
  • characterized by “serious violation of rules”
    
    • not “aggressive conduct”

Question 10

describe etiology and treatment & outcome of ODD and conduct disorder

Answer 10

• multi-factorial causes, possibly including:
  
  • child’s constitutional temperament
  • suboptimal parenting techniques
• treatment and outcome:
  
  • anger management & communication skills
  • parental training
  • variable outcome (concern is that behaviors escalate over time): ODD -> CD -> ASPD

Question 11

describe diagnostic criteria for intermittent explosive disorder (IED)

Answer 11

• recurrent outburts representing a failure to control aggressive impulses as manifested by either:
  
  • verbal aggression or non-damaging physical aggression occurring frequently
  • or
  • damaging physical aggression occuring infrequently
• aggression is:
  
  • grossly disproportionate to stressor
  • impulsive and/or anger-based (not instrumental)
  • not explained by other causes/disorders

Question 12

explain the differentials between IED and conduct disorder (CD) & ASPD

Answer 12

• CD & ASPD are characterized by habitual, pervasive and instrumental (not impulsive) antisocial behavior
• those with IED are usually not aggressive and don’t violate rights in-between explosive episodes

Question 13

explain the differential between IED and DMDD (disruptive mood dysregulation disorder)

Answer 13

• DMDD has severe temper outburts disproportional to stressor but with irritable baseline mood
  
  • IED doesn’t have an angry, irritable baseline mood

Question 14

describe diagnostic criteria for kleptomania

Answer 14

• diagnostic criteria
  
  • recurrent irresistible stealing of unneeded objects
  • increasing tension before stealing
  • pleasure, gratification or relief when stealing
  • no other cause or motivating factor for theft
• description: stolen items are unwanted and typically of low value; they are hoarded, given away or returned
• differential: “ordinary” shoplifting
  
  • object IS THE GOAL (not the process)
  • usually planned and assisted

Question 15

describe diagnostic criteria for pyromania

Answer 15

• diagnostic criteria
  
  • multiple episodes of deliberate fire setting with preceding tension or emotional arousal
  • fascination with fire & fire paraphernalia
  • pleasure, gratification or relief when setting fires or witnessing/participating in the aftermath
  • no other cause or motivating factor
• differential: arson (non-pyromaniac); need to assess motivation for setting fire

Question 16

describe the biochemical correlates of impulsivity

Answer 16

• decreased serotonin associated with poor prefrontal impulse control
• increased dopamine associated with rewarding sensation during impulsive act (stimulation of brain’s reward pathway)

Question 17

describe treatments for impulsivity

Answer 17

1. behavioral therapy
   
   • avoiding triggers of behavior or substituting a behavior when triggers are encountered
   • aversion therapy: punish impulse by applying something noxious
   • exposure and response prevention: expose person to trigger and don’t let impulsivity occur

Question 18

summarize disruptive, impulse-related & conduct disorders

Answer 18