Personality Disorders-Sweeny Flashcards
Describe the 3 clusters of personality disorders.
Cluster A - odd or eccentric
Cluster B - dramatic, emotional, erratic
Cluster C - fearful or anxious
Which personality disorders are Cluster A? (3)
- Paranoid
- Schizoid
- Schizotypal
Which personality disorders are Cluster B? (4)
- Histrionic
- Narcissistic
- Antisocial
- Borderline
Which personality disorders are Cluster C? (3)
- Avoidant
- Obsessive-compulsive
- Dependent
Paranoid Personality Disorder (clinical features and treatment)
- Pervasive and unjustified distrust and suspicion
- Secretive
- Cold and odd/affectively restricted
- Often hostile, angry, irritable (stress can induce short-lived psychosis)
- Few seek professional help on their own
- Psychopharmacologic intervention (antipsychotics and anti anxiety)
Schizoid Personality Disorder (clinical features, comorbidity and culture)
- Detachment; classic loner
- Restricted emotion. -Active imaginary lives.
- Indifferent to praise or criticism
- Little interest in sex; fear of intimacy
- Comorbidity w/schizotypal, paranoid and avoidant PDs
- Culture: immigrants from other countries, pts moving from rural to cities
Schizotypal Personality Disorder (clinical features and treatment)
- Discomfort with social relationships
- Odd and unusual dress and behavior
- Highly suspicious/paranoid
- socially isolated
- Peculiar patterns of thinking; illusions, ideas of reference, magical thinking
- Major depression in up to 50% who seek help
- May have short lived psychotic episodes (with stressor)
- Tx: social skills training, tx of comorbid depression, and low dose antipsychotic
What is the nature (3) of personality disorders?
- enduring pattern of inner experience and behavior that deviate from the individual’s culture
- patterns in (2+): cognition, affectivity, interpersonal functioning and impulse control
- inflexible and maladaptive, causing distress (may be egosyntonic–> does not r/o diagnosis if it doesn’t bother them)
If a patient with a suspected personality disorder is not aware of their impairment, can it still be diagnosed?
YES!
the pt can be egosyntonic
What 3 personality disorders have the highest genetic component?
schizotypal, antisocial and borderline personality disorder
What is the timeline qualification for a personality disorder diagnosis?
the PD presence is required by adolescence or early adulthood (even if it is not clinically diagnosed until later in life)
What are some clinical features of Antisocial Personality Disorder?
- failure to comply with social norms (problems w/law)
- violation of rights of others
- lack of conscience, empathy and remorse
- irresponsible, impulsive and deceitful
- manipulative
- “mask of sanity”
- genetic and environmental factors
- comorbidity: substance abuse, other PDs, sexual dysfunction, paraphilia, mood disorders, anxiety disorders
*NOT diagnosed before 18 yo and must have symptoms of conduct disorder before 15 yo
What is the difference between a diagnosis of conduct disorder and a diagnosis of antisocial personality disorder?
antisocial PD dx: must be at least 18 yo and had a history of conduct disorder before the age of 15 yo
if pt is >18 yo and does not meet antisocial PD criteria, conduct disorder dx can be given
What is necessary for a diagnosis of conduct disorder?
Repetitive and persistent pattern of behavior including 3 or more criteria in the past 12 months, with at least 1 criterion present in the past 6 months:
- Aggression to people and animals
- Destruction of property
- Deceitfulness or theft
- Serious violations of rules (i.e. run away from home overnight at least twice while living in parental home, or once without returning for a lengthy period).
If Antisocial PD is secondary to substance abuse, should it be diagnosed?
NO!
however, when APD and substance abuse both begin in childhood and continue into adulthood, BOTH should be diagnosed
What is the treatment for antisocial personality disorder?
- few seek voluntary treatment
- Emphasis is placed on prevention and rehabilitation through community based programs
- Goals: improving social skills, treating substance abuse, and managing impulse control
- group therapy
- pharmacotherapy
What are some clinical features of borderline personality disorder?
- unstable affect, mood swings (labile), unstable interpersonal relationships, intense anger
- impulsive
- fear of abandonment
- chronic feelings of emptiness or boredom
- comorbid: Major depressive disorder, alcohol and substance abuse
- stress–> micropsychotic episodes
- splitting =primary defense mechanism (good vs evil)
- rely on validation from others
- causes: familial, childhood sexual/physical/emotional abuse
What are some treatment options for borderline personality disorder?
antidepressants
mood stabilizers
first generation and atypical antipsychotics
dialectical behavior therapy*** (most promising)
What are some predictors of poor outcome BPD? better outcome?
poor:
- antisocial behavior
- chronic anger
- overuse of medical facilities
better:
- higher intelligence
- superior social supports
- increased self-discipline
What are some clinical features of histrionic personality disorder?
- overly dramatic, sensational and sexually provocative
- impulsive and need to be the center of attention
- suggestible
- shallow thinking and emotions
- improve over time, regardless of tx
- comorbid: often have major depressive disorder and/or anxiety d/o
- tx: psychodynamic therapy and comorbid disorders
What are some clinical features of narcissistic personality disorder?
- exaggerated and unreasonable sense of self-importance and entitlement
- preoccupied with fantasies of success
- lack sensitivity and empathy for other people
- react to criticism
- prone to depression with aging
- causes: failure to learn empathy as a child, lack of parental appreciation of accomplishments OR excessive attention
What are some characteristics of avoid ant personality disorder?
- extreme sensitivity to the opinions of others
- avoidant of interpersonal relationships as a self-protective measure
- shy away from social relationships because a fear of rejection and possible embarrassment
- few relationships
- causes: early rejection and overlaps with Axis I social phobia
- tx: SSRI and beta blockers and behavioral intervention
What are some clinical features of dependent personality disorder?
-*Subordinates own needs for those of others
-Reliance on others to make major and minor life decisions
-Unreasonable fear of abandonment
-Clingy and submissive in interpersonal relationships (abusive relationships)
-Associated features: self-doubt, excessive humility, poor independent functioning, mood d/o’s, anxiety.
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What are some clinical features of Obsessive-Compulsive Personality Disorder?
- excessive and rigid fixation on doing things –> strive for sense of control.
- perfectionistic
- irritated by others who do not value order
- obsessions and compulsions are absent or rare (unlike OCD)
- egosyntonic (don’t feel distressed)
- comorbid: major depressive disorder, dysthymia, and generalized anxiety
