Psych 14 - Personality d/o's Flashcards
Define personality.
The characteristics of an individual that are enduring, pervasive and distinctive.
- Consists of a person’s typical thoughts, core beliefs, behavior, emotional traits, temperament, and interpersonal style that assist the individual to cope with, and adapt to, internal/external demands and stressors.
What is a personality disorder (PD), per DSM V criteria?
What are the 3 P’s?
__ of __ patterns must be present: (list them)
When does it usually manifest by?
What must be present in order to dx someone under age 18?
Enduring pattern of inner experience and behavior that deviates markedly from an individual’s CULTURE. Causes clinically significant impairment in social, occupational or other important areas of fcning.
- Pattern lacks flexibility, and is pervasive, pernicious, and persistent (the 3 Ps).
Pattern manifests in 2 or > areas of functioning:
- Cognition (perception about themselves, others, events)
- Affectivity (range, intensity, lability, & appropriateness of emotional response)
- Interpersonal functioning
- Impulse control
- Onset by adolescence or early adulthood; childhood manifestations possible. If PD is diagnosed before the age of 18 years, features must be present for at least 1 year.
- Not due to drugs or medical condition
What is the 1st-aid way of remembering the 3 PD clusters?
Weird, Wild, and Worried (A, B, and C)
List the 3 PD’s seen in the “A” cluster.
Generally describe this cluster.
A (weird- “accusatory, aloof, awkward”)
- Paranoid
- Schizoid
- Schizotypal
Odd / eccentric presentation. Characterized by social withdrawal & deviant modes of social functioning.
List the 4 PD’s seen in the “B” cluster.
Generally describe this cluster.
B (wild- “bad to the bone”)
- Antisocial
- Borderline
- Histrionic
- Narcissistic
Dramatic / emotional. Characterized by poor impulse control & excessive emotionality.
List the 3 PD’s seen in the “C” cluster.
Generally describe this cluster.
C (worried- “cowardly, compulsive, clingy”)
- Avoidant
- Obsessive-compulsive
- Dependent
Anxious / fearful. Characterized by heightened sensitivity to social rejection, focus on conformity.
What are PD’s that don’t fit into categories A, B, or C called?
Mixed PD; PDs not yet classified
What childhood factors (2) are linked to a huge increased risk of developing a PD?
Abuse and neglect
List psych & medical conditions that are commonly co-morbid w/PDs.
MDD, GAD, substance-abuse
- More negative prognosis w/these
Pain conditions, obesity, risky behaviors, chronic fatigue, more use of medical system, etc.
How do pts w/PD’s commonly present to physicians?
W/ physical complaints
Describe a typical course of PD, throughout life (read).
Variability in symptoms is not unusual; for example, borderline PD may 1st present during adolescence, be quite symptomatic during early adulthood, attenuate during mid‐life, and recur during times of crises regardless of age.
List some “indicators” that you may be dealing w/a PD. (read)
- Pt or significant other reports, he/she has “always been that way”.
- There is a high degree of chaos in the pt’s personal life.
- Pts p/w atypical problems that don’t fit easily into other dx’s.
- The pt has poor insight into how his/her behavior impacts others, and blames others
for his/her problems. - Poor compliance with medical care.
- You have noticeable reactions to the patient’s behavior (countertransference), including feelings of
frustration, anger, helplessness, depletion, rescue fantasies, anxiety, and inadequacy.
Describe paranoid PD.
- Pervasive mistrust and suspiciousness
- Reluctant to confide in others, fears info will be used against them
- Angry, defensive, socially isolated.
Paranoid PD: More common M or F?
More common w/fam h/o _______ or _______.
Males
Schizophrenia, delusional disorder
Describe schizoid PD.
- Loners.
- Emotionally detached.
- Indifferent to the world.
- Restricted range of emotional expression.
(me)
Schizoid PD: More common M or F?
More common w/fam h/o _______ or _______.
Males
Schizophrenia, schizotypal PD
Describe schizotypal PD.
Eccentricities.
- Odd beliefs, magical thinking, superstitious.
- Speech: metaphorical, over elaborate.
Marked social anxiety, isolated except for 1st degree relatives
(Joe Rogan)
Pt’s w/ fam h/o ________ are more at risk for schizotypical PD.
What part of the brain is abnl in this dz?
Schizophrenia
Temporal cortex
Cluster A PD pts often use “projection.” Describe how this would manifest.
Acting as if one’s feelings/thoughts are rooted in other person. Manifests as mistrust, anger, hostility, leads to conflicts / confrontations.
How do some cluster A PD pts have schizoid fantasies?
Withdrawal into the world of imagination and excessive daydreaming to avoid social interaction and associated anxiety.
What type of life problems do cluster A PD pts have?
- Low stress tolerance.
- Interpersonal issues conflict with social norms (work, relationship problems, etc)
- Low adherence to medical care.
How should you manage pts w/cluster A PD?
- Be aware of counter-transference (uneasiness, anger; schizoid and schizotypal). PD patients test your patience, cause frustration.
- They have trust issues (use actions over words)
- *Avoid confrontation, don’t challenge them
What distinguishes cluster A PD’s from schizophrenia, delusional DO, and mood DO w/psychotic features?
Presence of chronic psychotic sx
Describe antisocial PD.
- Disregard for and violation of the rights of others (since at least 15 y/o).
- Socially irresponsible behaviors.
- Lack empathy and remorse.
(Can be glib and charming)
(Michael)
How old must pt be to dx antisocial PD?
If they are less than this age, what can they be dx’d with?
18
< 18 = conduct disorder
Is antisocial PD more common in M or F?
What parts of the brain are a/w antisocial PD?
Males
Serotonin dysfunction, frontal lobe dysfunction, low autonomic arousal and reactivity are some of the associated findings.
Describe borderline PD.
Borderline pts have increased risks of what?
What types of sx emerge under stress?
Pervasive pattern of instability: - Interpersonal relationships. - Identity or self‐image. - Marked anger, rage, fear. Impulsivity. (addictions) - Fear of abandonment, struggle with feelings of emptiness. CUTTERS!
- Increased rates of suicidal behavior and self injury (completed suicides in 8‐10%). Using suicide as a threat.
- Under stress, paranoid ideation and dissociative symptoms emerge.
(Sarah)
Is borderline PD more common in M or F?
Females
Describe histrionic PD.
- Dramatic w/ excessive emotionality.
- Attention-seeking.
- Entertaining…”the life of the party”.
- Poor frustration tolerance.
Is histrionic PD more commonly dx’d in M or F?
Females (under-dx’d in men?)
Describe narcissistic PD.
- Pathological sense of self‐importance.
- Sense of entitlement, see self as “special”, and believe they are best understood by other high status people.
- Lack empathy and are arrogant.
- Interpersonally exploitative
- Fragile self‐esteem; criticism evokes anger
(Aram, Trump)
What is a co-morbidity more a/w antisocial PD?
ADHD
Neurobiological correlates of antisocial and borderline PDs; dysregulation of ___________ and __________ systems.
Serotinergic and dopaminergic
(e.g., serotonergic activity is reduced in impulsive aggression).
What PD pts have generally smaller amygdalas on fMRI?
Borderline PD
List and describe the 5 behavior patterns of cluster B pts:
- Controlling (manipulation of people/events to reduce inner tension)
- Acting out (dealing with conflicts / stress through actions rather than talking -> impulsive behavior)
- Splitting (compartmentalizing emotions, behavior, and people into all good / all bad categories)
- Self-injury (emotionally numbing)
- Somatization (expressing emotional distress thru physical sx)
Which PD may have the greatest deal of trouble accepting help from others?
Narcissistic
W/cluster B PD’s, verbalize your intention to help the patient and attempt to satisfy ___________ requests.
reasonable
Describe avoidant PD.
- Socially inhibited and feel inadequate.
- Hypersensitive to negative evaluation.
- Avoid interpersonal contact, avoid conflict.
- Low self esteem
(Lina)
Is avoidant PD more common in M or F?
M = F
Describe dependent PD.
- Submissive behavior
- Go to great lengths to obtain nurturance & support.
- Want others to assume responsibility for major areas of his/her life.
- Feels unable to care for him/herself.
- Low self‐efficacy.
(Briana)
Describe obsessive-compulsive PD. (NOT OCD)
- Perfectionism, inflexibility and high need for mental/interpersonal control.
- Preoccupied with rules, efficiency, details and procedures.
- Over conscientious, micromanagers.
Is OC-PD more common in M or F?
Males (x2 dx)
List and describe the 4 behavior patterns of cluster C pts:
- Inhibition (of emotions and thoughts in order to avoid conflicts)
- Avoidance (of people and situations to reduce anxiety)
- Somatization (expressing emotional distress through physical symptoms)
- Intellectualization (isolation of feelings from thoughts)
Describe some things to keep in mind while managing cluster C PD pts.
- Countertransference (overprotective, frustrated, angry)
- Verbalize your willingness to care for avoidant and dependent pts
- Avoid power struggles w/OC-PD (provide explanations)
Avoidant PD may overlap w/_______________.
Social phobia
OC-PD is egos-_____________, OCD is ego-____________.
- Egosyntonic (unaware because part of person’s personality)
- Egodystonic (aware of problem and don’t like it)
List 2 therapeutic techniques for treating PD’s.
CBT, DBT (cognitive; dialetic)
What PD cluster(s) have psychotic agents proven efficacious for?
Cluster A and B
What PD cluster(s) have SSRIs proven efficacious for?
Can be augmented w/long-acting __________. If rage is prominent, add an ___________.
Cluster B (can be augmented w/long-acting benzo like clonazepam. If rage is prominent, add an antipsycotic). Cluster C (can be augmented w/long-acting anxiolytic- benzo like clonazepam)
Do antidepressants have an effect on impulsive behavior?
No
What effects do mood stabilizers have in PD’s?
- Very large effect on impulsive-behavior and anger
- Large effect on anxiety
- Moderate effect on depression
Take home pts (read)
- Most patients with PD seek behavioral health services at urging of family or employer
- Strive for empathy and to understand the pt’s behavior
- While behavior is maladaptive, patient’s goal is to minimize internal distress, and meet personal needs
- Survival mechanism
- Don’t personalize the patient’s behavior
- Refer patients for psychotherapy and consider evidence based psychopharm for targeted symptoms
