Personality Disorders; OCD and Related Disorders Flashcards
1
Q
Personality disorders
A
- Cluster A - Weird
- Paranoid
- Schizoid
- Schizotypal
- Cluster B - Wacky
- Borderline
- Narcissistic
- Histrionic
- Antisocial
- Cluster C - Worried
- Avoidant
- Dependent
- Obsessive compulsive
2
Q
Paranoid Personality Disorder
A
- MC: men, first degree relative of schizophrenic, hostile, argumentative, hypervigiliant
- sxs: distrust and suspiciousness of others - motives interpreted as malevolent, 4+ of following:
- suspects without sufficient basis, that others are exploiting, harming, or deceiving them
- preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
- reluctant to confide in others because of unwarranted fear that info with be used maliciously against him/her
- reads hidden demeaning or thretening meanings into benign remarks or events
- persistently BEARS GRUDGES (unforgiving of insults, injuries, or slights)
- perceives attacks on his/her character or reputation that are not apparent to others and is quick to react angrily or to counterattack
- has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner = JEALOUSY
- tx: PSYCHOTX, avoid confrontation - counterproductive and reinforces their beliefs
3
Q
Schizoid personality disorder
A
- loner without seeming need for much human relatedness
- MC: men, first deg relative of schizophrenic (i.e. night watchmen without many friends)
- sxs: detachement from social relationships and restricted range of expressive emotions in interpersonal settings; 4+ of the following:
- neither desires nor enjoys close relationships, including being part of a family
- almost always chooses solitary activities
- has little interest in sexual experiences
- takes pleasure in few activities
- lacks close friends or confidants other than first degree relatives
- appears indifferent to praise or criticism of others
- shows emotional coldness, detachment, or flat affect
- signs: may have constricted affect, seems distant, anhedonia, flat affect, emotionally blunted
- tx: individual psychotx, NOT GROUP
4
Q
Schizotypal personality disorder
A
- genetic relationship to schizophrenia? regarded as “odd or eccentric”, fascinated by unusual ideas, but unlike pts with delusions, willing to consider alternatives if facts are presents
- MC: 1st deg relative of schizophrenic
- sxs: social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior; 5+ of the following:
- ideas of reference
- odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms
- unusual perceptual experiences, including bodily illusions
- odd thinking and speech (vague, circumstantial, metaphorical, overelaborate, or stereotyped)
- suspiciousness or paranoid ideation
- behavior or appearance that is odd, eccentric, or peculiar or unkempt
- lack of close friends or confidants otther tthan first-deg relatives
- excessive social anxiety that doesnt diminish with familiarity
- DOES NOT HAVE DELUSIONS OR HALLUCINATIONS
- signs: paranoid ideas (not frank delusions), inappropriate, constricted affect, speech is circumstantial, metaphorical, vague ideas of reference, laugh . inappropriately while discussing their problems, talk to themselves in public, gesture for no reason
- tx: psychotx (not motivated to seek tx)
- comorbidities: anxiety disorder, MDD
5
Q
Borderline Personality Disorder
A
- hostile/angry, dependent/child-like
- RF: childhood hx of abuse or parental neglect, mostly female, 1st deg relative (5x)
- sxs: instability in personal relationships, self-image, and affective regulation, marked impulsivity that is potentially self-damaging, inappropriate, intense anger or conttrol of anger, recurrent suicidal attempts, gestures or threats, and identity disturbances
- frantic efforts to avoid real or imagined abandonment
- unstable and intense interpersonal relationships
- identity disturbance (markedly and persistently unstable self-image or sens of self
- impulsivity in at least 2 areas that are self-damaging (spending, sex, substance abuse, reckless driving, binge eating)
- recurrent suicidal behavior, gestures, threats or self-mutilating behavior
- affective instability dt a marked reactivity of mood (intense episodic dysphoria, irritability, or anxiety lasting a few hours and only rarely more than a few days)
- chronic feelings of emptiness
- inappropriate, intense anger or difficulty controlling anger (recurrent physical fights, constantt anger, temper)
- transient, stress related paranoid ideation
- signs: idealize versus devalue (overvalue some and devalue others depending on their perception of others’ intentions, interest, and level of caring
- countertransference (stirrup strong feelings to rescue/take care of others)
- splitting (see others and themselves as wholly good or totally bad)
- self-harm (cutting)
- chronic dysphoria common (desperate dependence on others cause by inability to tolerate being alone
- tx: psychotherapy, SSRI
- Comorbidity: mood disorder
6
Q
Narcissistic personality disorder
A
- mostly males, <1%, described as arrogant, envious, exploitative
- sxs: pattern of grandiostiy (in fantasy or behavior), need for admiration and lack of empathy; 5+ of following:
- grandiose sense of self-importance (exaggerates talents, achievements, expects to be recognized as superior without commensurate achievements)
- preoccupied with fantasies of unlimited success, power, billiance, beauty, or ideal love
- believes he or she is special and unique and can only be understood by, or should associate with, other special . or high-status people
- requires excessive admiration
- sense of entitlement (unreasonable expectations of favorable treatment)
- interpersonally exploitative
- lacks empathy
- envious
- shows arrogant, haughty behaviors or attitudes
- tx: psychotx, lithium (use if mood swings are prominent), antidepressants (if comorbid depression)
7
Q
Histrionic personality disorder
A
- dramatic, strong affect, sexualization/flirtatious, vague/over inclusive (overfamiliar in history giving), mostly female
- sxs: excessive emotionality and attention seeking; 5+ of following:
- uncomfortable in situations where he/she is not center of attention
- interaction with others characterized by inappropriate sexually seductive or provocative behavior
- rapidly shifting and shallow expression of emotions
- uses physical appearance to draw attention to self (attention seeker)
- has a style of speech that is excessively impressionistic and lacking in detail
- shows self-dramatization, theatricality, and exaggerated expression of emotion
- suggestible (easily influenced by others)
- considers relationships to be more intimate than they actually are
- tx: psychotx
8
Q
Antisocial personality disorder
A
- strong genetic component, criminal activity, fights with weapons, hx of rape/assault
- M:F 3:1
- RF: 1st deg relative with ASPD, fail in roles requiring fidelity (spouse), honestly (employee), or reliability (parent)
- sxs: disregard for and violation or rights of others, occuring since age 15; 3+ of following:
- failure to conform to social norms with respect to lawful behaviors
- deceitfulness
- impulsivity or failure to plan ahead
- irritability and aggressiveness (physical fights, assaults)
- reckless disregard for safety or self/others
- consistent irresponsibility (repeated failure to sustain consistent work behavior or honor financial obligations)
- lack of remorse or empathy (being indifferenct to or rationalizing having hurt, mistreated, or stolen from another
- tx: perform CAGE questionnaire, inpt self-help groups, psychotropics, anticonvulsants, lithium, BB
- prognosis: often have ODD that then develops into conduct disorder and onto ASDP later in life
9
Q
Avoidant personality disorder
A
- self-deprecating, fear of getting hurt, moody (apologizes a lot)
- sxs: social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation; 4+ of following:
- avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection
- unwilling to get involved with people unless certain of being liked
- shows restraint with intimate relationships because of fear of being shamed or ridiculed
- preoccupied with being criticized or rejected in social situations
- inhibited in new interpersonal situations because of feelings of inadequacy
- views self as socially inept, personally unappealing, or inferior to others
- unusually reluctant to take personal risks or engage in any new activities because may prove embarrassing
- signs: timid, social awkwardness, apologetic demeanor (hate to bother others, guilty)
- tx: individual or group psychotx, BB, SSRI if social phobia
- comorbidities: depression, anxiety, substance abuse (ETOH)
10
Q
Dependent personality disorder
A
- Mostly women
- RF: childhood illness or separation anxiety disorder
- sxs: excessive need to be taken care of that leads to submissive and clinging behavior and fears of seaparation; 5+ of following:
- has difficulty making everyday decisions without an excessive amoutn of advice and reassurance from others
- needs others to assume responsibility for areas of hix/her life
- has difficulty . expressing disagreement with others because of fear of loss of support or approval
- difficulty initiating projects or doing things on his/her own (lack of self confidence in judgement or abilities, rather than lack of motivation or energy)
- goes to excessive lengths to obtain nurturance and support from others, to point of volunteering to do things that are unpleasant
- feels uncomfortable or helpless when alone because of exaggerated fears of beign unable to care for him/herself
- urgently seeks another relationship as a source of care and support when close relationship ends
- unrealistically preoccupied with fears of being left to care for him/herself
- tx: psychotx (insight oriented), frequent short visits that are not crisis-driven, allow then to keep aspects of “sick role” without needing to escalate
- associated: increased risk for mood and anxiety disorders
11
Q
Obsessive compulsive personality disorder
A
- mostly males (2:1)
- RF: 1st deg relative, differentiate from OCD (egodystonic), “I should” phase (captures overly high standards, drive, perfecitonism, rigidity, and devotion
- sxs: preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency; 4+ of the following:
- preoccupied with details, rules, lists, order, organization, or schedules to extent that major point of activity is lost
- perfectionism interferes with task completion (strict standards not met, unable to complete)
- excessively devoted to work and productivity to exclusion of leisure activities and friendships
- over conscientious, scrupulous, and inflexible about matters of morality, ethics, or values
- unable to discard worn-out or worthless objects when they have no sentimental value
- reluctant to delegate tasks or to work with others unless they . submit exactly to his/her way
- adopts a miserly spending style toward botth self and others; money viewed as something to be hoarded for future catastrophes
- shows rigidity and stubbornness
- signs: orderly, scheduled, regular - hate spontaneity, denies feelings, meticulous, effortful
- tx: high dose SSRIs or clomipramine (serotonergic TCA), FDA approved (fluvoxamine, paroxetine, sertraline, fluoxetine)
12
Q
Body dysmorphic disorder
A
- F>M, specifier with muscle dyspmorphobia, almost always male
- sxs: preoccupation with at least one noonexistent or slight defect in physical appearance (thinks about it >1h/d), at some point concerns about appearance lead to repetitive behaviors (mirror checking, excessive grooming, skin picking) or mental acts (comparing one’s appearance to others), clinically significant stress or psychosocial impairment that results from appearance concerns, preoccupations not better explained by eating disorder
- tx: SSRIs or clomipramine, fluoxetine or escitalopram (decrease obsessive preoccupations, compulsive behaviors, and fnal imairment), cognitive behavioral tx
- comorbidities: unipolar major depression or social anxiety disorder, bipolar disorder, substance use disorder
13
Q
obsessive compulsive disorder
A
- mostly males (2:1)
- RF: 1st deg relative
- comorbidities: depression (MC), other anxiety disorders, eating disorders, tics
- Onset in early adulthood, but childhood inset is not rare
- sxs: onset is gradual with waxing and waning course
- fears of contamination and germs (common), handwashing, counting behaviors, and having to check and recheck such actions as whether door is locked, activities take up >1h/d, undertaken to relive anxiety triggered by core fear, want to control their feelings and emotions of others
- signs: chafed and reddened hands, patchy hair loss (trichotillomania)
- tx: pharmacotherapy (high-dose SSRIs or clomipramine), deep brain stim, behavior tx (systemic desensitization - gradually increase exposure to stressful situations)
- only 50-60% benefit from meds only
- prognosis: 40% of pts will experience remission as adults
