Personality , Somatic, and Eating Disorders

Question 1

Differentiate between cluster A, B, and C personality disorders.

Answer 1

A: pt. viewed as weird or peculiar –> associated with psychotic disorders
B: pt. viewed as emotional or inconsistent –> associated with mood disorders
C: pt. is fearful / anxious –> associated with anxiety disorders

Question 2

Name and describe the types of cluster A personality disorders.

Answer 2

Schizotypal: magical thinking (superstitious, clairvoyance, etc.), metaphoric speech, aloof, isolated
Schizoid: few friends, loner, indifferent to praise/criticism, do not enjoy/desire close relationships
Paranoid: suspicious, emotionally cold, humorless, blame others, appear hostile & angry, holds grudges

Question 3

Name and describe the types of cluster B personality disorders.

Answer 3

Borderline: self-destructive, erratic emotions, impulsive, sexual, always in a crisis
Antisocial: breaks laws, violates rights of others, no remorse or guilt, appears friendly on surface
Histrionic: false emotions, dramatic, center of attention, excitable, seductive.
Narcissistic: can’t apologize, grandiose, lacks empathy, inflated self-image but fragile self-esteem

Question 4

Name and describe the types of cluster C personality disorders.

Answer 4

Dependent: lacks self-confidence, constantly needs reassurance, will not initiate things
Avoidant: awkward in social situations, desires relationships but avoids them s/p inferiority complex
OCD: perfectionist, preoccupied with details

Question 5

Which personality disorder is most likely to progress to schizophrenia?

Answer 5

Schizotypal

Question 6

What is important for the therapist to keep in mind when managing paranoid personality disorder?

Answer 6

The paranoia manifested is often a by-product of a fragile self-concept.

Question 7

Which childhood disorder is antisocial personality disorder most similar to?

Answer 7

Conduct disorder –> DSM-V requires patient to have characteristics of conduct disorder prior to age 15 in order to diagnose anti-social personality disorder.

Question 8

Which personality disorders are significantly more prevalent in women than in men?

Answer 8

Borderline personality disorder

Question 9

What is the most promising treatment for borderline personality disorder?

Answer 9

Dialectic behavioral therapy (DBT)

Question 10

Describe a patient with body dysmorphic disorder.

Answer 10

Pt. feel self-conscious and fear humiliation, go to great lengths to hide or correct perceived anomaly, stress from external expectations and cultural norms

Question 11

What is the most common body part area of fixation in body dysmorphic disorder?

Answer 11

Face

Question 12

What is the most common age of onset and what is the treatment for body dysmorphic disorder?

Answer 12

Age: 15-20
Treatment: high dose SSRIs

Question 13

Define egosyntonic and describe which personality disorder it relates to.

Answer 13

Def: condition not distressing to the patient.

OCD patients are egosyntonic

Question 14

Describe factitious disorder.

Answer 14

Intentionally fake signs/symptoms of medical or psychiatric conditions

Question 15

What is the term formerly used to describe factitious disorder imposed on self?

Answer 15

Munchausen Syndrome

Question 16

What is the term formerly used to describe illness anxiety disorder?

Answer 16

Hypochondriasis

Question 17

Describe illness anxiety disorder.

Answer 17

Preoccupation with belief of having or fear of contracting serious illness.

Question 18

What is the most common age of onset of illness anxiety disorder?

Answer 18

Early to middle adulthood

Question 19

What comorbid psychiatric conditions are commonly present with illness anxiety disorder?

Answer 19

Anxiety and depression

Question 20

T/F: Patients with illness anxiety disorder should avoid regular appointments with medical providers.

Answer 20

False: Regular appointments provide reassurance.

Question 21

Describe somatic symptom disorder.

Answer 21

Patient presents with vague physical complaints that can’t be explained by a medical condition or substance use. But patient is not being intentionally deceptive about their symptoms.

Question 22

Describe the DSM-V criteria for diagnosis of somatic symptom disorder.

Answer 22

6+ months of 4 pain symptoms - 2 GI complaints, 1 sexual symptom, and 1 pseudoneurological symptom - not explained by a medical condition.

Question 23

Define malingering.

Answer 23

Purposefully feign physical symptoms for external gain with the most common goal being to obtain drugs or shelter (ED) or financial gain (clinic).

Question 24

Classify anorexia nervosa based on BMI.

Answer 24

Mild: BMI > 17
Moderate: BMI 16 - 17
Severe: BMI 15 - 16
Extreme: BMI < 15

Question 25

Describe two types of anorexia nervosa.

Answer 25

Restricting - eats very little with no binge and purge

Binge and purge

Question 26

Describe S/S commonly associated with anorexia nervosa.

Answer 26

emaciation, bradycardia, orthostatic hypotension, peripheral edema, amenorrhea, salivary gland enlargement, dental erosion, lanugo (soft, feathery hair)

Question 27

What electrolyte and serum lab abnormalities are common in anorexia nervosa?

Answer 27

Leukopenia, metabolic alkalosis, increased BUN, dec estrogen, inc cortisol, dec vitamin D, inc amylase, hypokalemia, hypocalcemia, hyponatremia.

Question 28

Why are patients with anorexia nervosa at higher risk of fractures?

Answer 28

Dec estrogen, Ca, vitamin D, and inc cortisol

Question 29

What is the first goal in the treatment of anorexia nervosa and how is it accomplished?

Answer 29

Restore nutrition –> done gradually to avoid refeeding syndrome. Requires hospitalization if patient is < 20% expected body weight.

Question 30

What antidepressant medication is contraindicated in anorexia nervosa and why?

Answer 30

Bupropion –> decreases seizure threshold and anorexia patients are already at increased risk of seizures s/p hyponatremia.

Question 31

What anti-psychotic medication may be used in the treatment of anorexia because of its propensity to cause weight gain?

Answer 31

Olanzapine (Zyprexa)

Question 32

Describe the pathophysiology of refeeding syndrome if the restoration of nutrition in an anorexia patient is not handled properly.

Answer 32

Phosphate stores are depleted during starvation. If carbohydrates are introduced aggressively, insulin triggers cellular uptake of phosphate leading to hypophosphatemia leading to cardiac arrhythmias.

Question 33

What is the general treatment approach for anorexia nervosa?

Answer 33

Requires a multi-disciplinary approach

Question 34

Describe what is required for the diagnosis of bulimia nervosa.

Answer 34

Binge eating + vomiting, laxatives, diuretics, excessive exercise, etc 1 day per week for 3+ months.

Question 35

Describe the typical weight of a patient with bulimia nervosa.

Answer 35

Rapid fluctuations in weight are noted but they typically maintain a normal or near normal BMI.

Question 36

How is the severity of bulimia nervosa classified?

Answer 36

Mild: 1 - 3 episodes per week
Moderate: 4 - 7 episodes per week
Severe: 8 - 13 episodes per week
Extreme: 14+ episodes per week

Question 37

What is the first line therapy for bulimia nervosa?

Answer 37

CBT - hospitalization usually not required unless SI.

Question 38

Describe the diagnostic criteria for binge eating disorder.

Answer 38

1+ episode per week for 3+ months. Episode defined as eating more in a two hour period than an average person would. Not followed by any weight loss efforts.

Question 39

How is the severity of binge eating disorder classified?

Answer 39

Same as bulimia...
Mild: 1 - 3 episodes per week
Moderate: 4 - 7 episodes per week
Severe: 8 - 13 episodes per week
Extreme: 14+ episodes per week

Question 40

What eating characteristics are associated with binge eating disorder?

Answer 40

Eating faster than normal, eating until uncomfortably full even when not hungry, eating alone out of embarrassment, guilty or depressed after episode.