Personality Disorders-Kohlenberg

Question 1

How many personality disorders are there?

Answer 1

10 w/ A, B & C clusters

Question 2

How do you evaluate personality disorders?

Answer 2

instead of strict criteria, you more see that a patient fits into a cluster
ex: may see that they trust no one & have a paranoid type of personality disorder

Question 3

What is parasuicide?

Answer 3

ex: cuts

not meant to kill yourself, but has that vibe

Question 4

What is the #1 thing used to reduce parasuicidal behavior?

Answer 4

Dialectical Behavior therapy

Question 5

Chip, a 24 year old new patient, sees his primary care doctor for a bad cough. He is dressed eccentrically and he asks about the doctor's astrological sign. He is in a rush to get the prescription for antibiotics because he believes they will work best if taken exactly on the hour. Eye contact is poor. Which personality disorder is the most appropriate diagnosis? 

a. Schizoid Personality Disorder 
b. Schizotypal Personality Disorder 
c. Paranoid Personality Disorder 
d. Antisocial Personality Disorder 
e. Borderline Personality Disorder 

Answer 5

B. Schizotypal.

Question 6

How does it feel to have a personality disorder?

Answer 6

ego-syntonic

miserable: relationship failures, depression, suicide

Question 7

What is ego syntonic & dystonic?

Answer 7

ego dystonic: I have an issue w/ depression. This isn’t who I am & I want to be better.
ego syntonic: I’m alright–everyone else is messed up.

Question 8

Who is Tony Soprano an example of?

Answer 8

someone w/ antisocial personality disorder

only presents to the psychiatrist for an anxiety disorder

Question 9

What is a personality?

Answer 9

a common way that a person feels & behaves across situations.

Question 10

How does personality or “self” develop?

Answer 10

develops through interactions with others
ex: caregiver relationship is very important. If they constantly abuse you-you may not have a sense of your needs or personality.

Question 11

What is the relationship w/ childhood neglect & developing a personality disorder?

Answer 11

children who have been abused 4X more likely to be diagnosed w/ a PD.
73% of PD patients were abused as children.

Question 12

What are the 6 key elements of personality disorders?

Answer 12

1. enduring pattern of inner experience & behavior
2. this enduring pattern is inflexible & pervasive
3. pattern leads to clinically significant distress or impairment in social or occupational areas of functioning
4. The pattern is of long duration, onset in adolescence or early adulthood.
5. Not better explained as a manifestation or consequence of another mental disorder.
6. Not due to physiological effects of a substance or medical condition.

Question 13

Describe the onset of a personality disorder.

Answer 13

**never new onset
evaluate long term functioning
evident in early adulthood
rarely diagnosed in kids

Question 14

TF Personality disorders are a subtype of situation/mood disorders, anxiety disorders, substance abuse.

Answer 14

False.

Question 15

What is Cluster A of personality disorders?

Answer 15

Odd or eccentric (paranoid, schizoid, schizotypal)

Question 16

What is Cluster B of personality disorders?

Answer 16

Dramatic, emotional, erratic (antisocial, borderline, histrionic, narcissistic)

Question 17

What is Cluster C of personality disorders?

Answer 17

Anxious, fearful (avoidant, dependent, obsessive compulsive personality disorder)

Question 18

What is paranoid personality disorder?

Answer 18

A pattern of pervasive distrust and suspiciousness of others such that their motives are considered malevolent. Begins in early adulthood, across a variety of contexts.

is reluctant to confide in others because of fears that the information will be used against him or her
reading insults into benign remarks
persistently bears grudges, is unforgiving of insults, injuries, or slights

perceives attacks on his or her character or reputation that are not apparent to others and is quick to react or to counterattack
has recurrent suspicions, w/o justification, regarding fidelity of spouse or sexual partner

Question 19

How does paranoid personality disorder differ from paranoid schizophrenia?

Answer 19

paranoid schizophrenia has clear cut delusions that are specific & not pervasive across different contexts.
these delusions may come & go.

Question 20

What is schizoid personality disorder?

Answer 20

A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions–beginning by early adulthood.
does not desire or enjoy close relationships, including being part of a family

Neither desires nor enjoys close relationships, including being part of a family.
Has little interest, if any, in sexual experiences with another person
takes pleasure in few, if any, activities
lacks close friends or confidants other than first-degree relatives
appears indifferent to the praise or criticism of others
shows emotional coldness, detachment, or flattened affectivity

Question 21

T/F Schizoid personality disorder is a part of schizophrenia?

Answer 21

False. Does not occur during the course of Schizophrenia, Mood Disorder w/Psychotic features…

Question 22

Is schizoid personality disorder an avoidant personality disorder?

Answer 22

no, b/c they have a preference for being alone

Question 23

What is schizotypal personality disorder?

Answer 23

A pervasive pattern of social and interpersonal deficits marked by discomfort with, and reduced capacity for, close relationships as well as by cog. or perceptual distortions and eccentricities of behavior.

odd beliefs or magical thinking
unusual perceptual experiences–including bodily illusions
odd thinking and speech peculiar behavior or appearance
suspiciousness or paranoia
inappropriate or constricted affect

Question 24

T/F Schizotypal personality disorder is a part of schizophrenia.

Answer 24

False.

Question 25

Once again, what are types of cluster A personality disorder?

Answer 25

paranoid personality disorder
schizoid personality disorder
schizotypal personality disorder

Question 26

What is antisocial personality disorder?

Answer 26

A pervasive pattern of disregard for, and violation of, the rights of others that occurs that began in childhood or early adolescence and continues into adulthood.
Must be at least 18 to receive this dx.

Question 27

What is the DSM5 criteria for antisocial personality disorder? Personality functioning

Answer 27

impairments in personality disorder
pathologic personality traits
A. personality functioning–
1. impairments in self functioning
**identity: ego centrism, self esteem derived for personal gain, power or pleasure
**self-direction:goal setting for personal gain, absence of prosocial internal standards
2. impairments in interpersonal functioning
**empathy:lack of concern for other’s feelings, needs, sufferings, lack of remorse for hurting others
**intimacy:can’t have mutually intimate relationships, exploit people, use dominance, deceit

Question 28

What is DSM5 criteria for antisocial personality disorder?

Personality traits

Answer 28

B. Pathologic Personality Traits:

1. Antagonism
   a. manipulativeness
   b. deceitfulness
   c. callousness
   d. hostility
2. Disinhibition
   a. irresponsibility
   b. impulsivity
   c. risk taking

Question 29

What are other DSM 5 criteria for antisocial personality disorder?

Answer 29

C. Impairments in personality functioning & the individual’s personality trait expression are relatively stable across time & consistent across situations
D. not better understood as normative to culture or developmental stage
E. not solely due to physiological effects of a substance or medical condition
F. individual at least 18 yo

Question 30

People with antisocial personality disorder are usu treated voluntarily?

Answer 30

No, usu involuntary in jail or something

Question 31

What does psychopathy screen for?

Answer 31

personality disorder-antisocial
glib & superficial charm
grandiose self worth
need for stimulation or proneness to boredom
pathological lying
lack of remorse or guilt
shallow affect
callousness & lack of empathy
parasitic lifestyle
poor behavioral controls
promiscuous sexual behavior
early behavior problems
lack of realistic long term goals
impulsivity
irresponsible
failure to accept responsibility for actions
many short term marital relationships 
juvenile delinquency
revocation of condition release
criminal versatility

Question 32

What is borderline personality disorder?

Answer 32

Pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins in early adulthood and is present in a variety of contexts.
frantic efforts to avoid real or imagined abandonment
idealized and devalued interpersonal relationships

identity disturbance–unstable sense of self
impulsive behavior–$, sex, substance abuse, reckless driving, etc……
affective instability–reactivity of mood
chronic feelings of emptiness
recurrent suicidal behavior or self-mutilation
inappropriate anger
stress related paranoid ideation or dissociative symptoms

Question 33

What is a good treatment for borderline personality disorder?

Answer 33

dialectical behavior disorder-reduces symptoms by 80%

Question 34

T/F Borderline personality disorder is as common as schizophrenia or bipolar disorder.

Answer 34

True.

Question 35

What is the biological aspect of borderline personality disorder?

Answer 35

much more emotional dysregulation
higher sensitivity
higher reactivity
longer lasting arousal
mood instability

Question 36

T/F A perfectly nice mom can abuse a child with borderline personality disorder without even thinking about it.

Answer 36

True. b/c perfectly fine things can traumatize a kid w/ BPD.

Question 37

What are the functions of self-injurious behavior?

Answer 37

Almost all (80-94%) self-mutilators report a decrease in negative emotion and shame after cutting.
Self-mutilators often report that self-injury helps them feel as if they exist during periods of profound emptiness or dissociation.

Question 38

Give more info about DBT that helps treat BPD.

Answer 38

Linehan’s work
Skills focused on inner experience
emotional dysregulation, mindfulness, wise mind
Skills focused on effectiveness in the world (chain analysis, problem solving, affirmation, the dialectic)
**gives BPD patients a tool kit to handle their emotions & analyze why they are feeling what they are feeling.

Question 39

What is wise mind?

Answer 39

the intersection of rational/logical mind & emotional mind

Question 40

What is histrionic personality disorder?

Answer 40

Pervasive and excessive emotionality and attention-seeking behavior
begins in early adulthood

Colorful, dramatic, extroverted, excitable and emotional. Males can act tough and macho. And a deep seated inability to maintain strong, reciprocal, and long-lasting friendships.
Love attention, unable to be ignored, shallow.

Question 41

What is narcissistic personality disorder?

Answer 41

A pervasive pattern of grandiosity, need for admiration, and lack of empathy that begins in early adulthood
grandiose sense of self importance
preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love
believes he or she is special or unique

requires excessive admiration
sense of entitlement
interpersonally exploitative
lacks empathy
envious of others and thinks others envy him or her
arrogant and haughty

no ability to be empathic
common in adolescents–not predictive of adult NPD
2-16% in the clinical population, 1% in gen. population
no heritability

Question 42

What is cluster b personality disorders?

Answer 42

antisocial PD
borderline
histrionic

Question 43

What are cluster c personality disorders?

Answer 43

**tend to be anxious & fearful.
avoidant
dependent
obsessive compulsive personality disorder

Question 44

What is avoidant personality disorder?

Answer 44

a pervasive pattern of social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation
avoids jobs that involve interpersonal contact, due to fears of disapproval or rejection
unwilling to get involved with people unless certain of being liked

shows restraint within intimate relationships because of fear of being shamed or ridiculed
is preoccupied with being criticized or rejected in social situations

Question 45

How can you tell avoidant PD from schizoid PD?

Answer 45

avoidant: want social interactions etc but fear & anxiety prohibit them
schizoid: disinterested

Question 46

Which personality disorder does Glenn Close have when she boils the bunny?

Answer 46

borderline personality disorder

Question 47

What is the difference b/w social anxiety disorder & avoidant personality disorder?

Answer 47

social anxiety but treatable, not to the level of –I don’t want to go to the bank b/c I will do something wrong & they will make fun of me. More like: I’m nervous about going on a date.

Question 48

What is dependent personality disorder?

Answer 48

pervasive need to be taken care of that leads to submissive and clinging behavior and fears of separation
has difficulty making everyday decisions without advice from others
needs others to assume responsibility for most major areas in life
has difficulty disagreeing with others

Question 49

What is obsessive compulsive personality disorder?

Answer 49

A preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.
preoccupied with details, rules, order–to the extent that the major point of an activity is lost
shows perfectionism-interferes with task completion

is excessively devoted to work and productivity, excludes leisure activity and friendships
is overconscientious, and inflexible about matters of morality, ethics or values
is unable to discard worn-out of worthless objects even with no sentimental value
is reluctant to delegate tasks (w/o assurance)

Question 50

What is the difference b/w obsessive compulsive disorder & obsessive compulsive personality disorder?

Answer 50

OCD: huge amount of suffering, want more. compulsive thoughts/behaviors.
OCPD: personality style, not in misery.