Personality disorders, obsessive compulsive disorders

Question 1

Etiology of borderline personality d/o

Answer 1

Neurobiologic development is affected by a combination of disruption of early attachments and subsequent trauma leading to hyperresponsiveness of the attachment system

Question 2

DSM-5 criteria for borderline personality d/o

Answer 2

A pervasive pattern of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five or more of the following;

1. Frantic efforts to avoid real or imagined abandonment (do not include suicidal or self-mutilating behavior)
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
3. Identity disturbance: markedly and persistently unstable self-image or sense of self
4. Impulsivity in at least two areas that are potentially self-damaging
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. Affective instability d/t a marked reactivity of mood
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger
9. Transient, stress-related paranoid ideation or severe dissociative sx

Question 3

Workup of borderline personality disorder

Answer 3

More of a clinical dx

Question 4

Tx of borderline personality disorder

Answer 4

Dialectical behavior therapy, with the following principles:
-Mindfulness
-Interpersonal effectiveness
-Emotional regulation
-Distress tolerance without impulsivity
Therapist must combine elements of conflict resolution and social learning
Limit inpt tx when possible
Use SSRIs when necessary

Question 5

Etiology of narcissistic personality disorder

Answer 5

Exact mechanism unknown

Most theories rely on unhealthy parent-child relationships as the basis of the disorder

Question 6

DSM-5 criteria for narcissistic personality disorder

Answer 6

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five or more of the following:

1. Has a grandiose sense of self-importance
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
4. Requires excessive admiration
5. Has a sense of entitlement
6. Is interpersonally exploitative
7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
8. Is often envious of others or believes that others are envious of him or her
9. Shows arrogant, haughty behaviors or attitudes

Question 7

Screening for narcissistic personality d/o

Answer 7

Personality tests, such as

• Personality Diagnostic Questionnaire-4
• Millon clinical Multiaxial Inventory III
• International Personality Disorder Examination

Question 8

Tx of narcissistic personality disorder

Answer 8

Psychoanalytic psychotherapy
No particular meds for NPD, but others can alleviate some sx
-SSRIs
-Antipsychotics
-Mood stabilizers

Question 9

Etiology of avoidant personality disorder

Answer 9

Some of the genes related to the personality trait of introversion, such as brain derived neurotrophic factor
Amygdala
Dysregulation in the brain’s dopamine system
Parenting behaviors, such as low parental affection or nurturing
Childhood emotional abuse

Question 10

DSM-5 criteria for avoidant personality disorder

Answer 10

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four or more of the following:

1. Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection.
2. Is unwilling to get involved with people unless certain of being liked
3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
4. Is preoccupied with being criticized or rejected in social situations
5. Is inhibited din new interpersonal situations because of feelings of inadequacy
6. Views self as socially inept, personally unappealing, or inferior to others
7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing

Question 11

Workup for avoidant personality disorder

Answer 11

Young children should receive an audiology exam to r/o hearing problems
Clinicians may want to consider using rating scales or standardized diagnostic interviews designed for the quantitative assessment of personality d/os and other psychiatric d/os

Question 12

Tx of avoidant personality disorder

Answer 12

Encourage pts to participate in as many social activities as can be tolerated