psych personality disorders Flashcards
personality disorders def
deeply ingrained, inflexible patterns of relating to others that are maladaptive and cause signif impairment in functioning; these are axis II disorders
insight in personality disorder?
no
dsm IV criteria for personality disorder
pattern of behavior that deviates from the person’s culture and is manifested in two or more of listed ways; the pattern is pervasive, inflexible, stable an dhas onset no later than adolescnece
personality disorder onset
must be no later than adolescence or early adulthood
personality disorders cluster A
schizoid, schizotypal, paranoid
personality disorders cluster B
antisocial, borderline, histrionic, and narcissistic
personality disorders cluster C
avoidant, dependent, and obsessive compulsive
cluster A description
patients are eccentric, peculiar, or withdrawn; familiar assoc with psychotic disorders
cluster B description
pateitns seem emotional, dramatc, or inconsistent; familial assoc with mood disorders
cluster C description
patients seem anxious or fearful; famiial assoc with anxiety disorders
personality disorder NOS
includes disorders that do not fit into a cluster (incl passive-aggressive personality disorder and depressive personality disorder)
treatment for personality disorders
usually pharm tx not helpful (with exceptions); psychotherapy and group therapy are the most helpful
paranoid personality disorder
pervasive distrust and suspiciousness of others and oten interpret motives as malevolent; blame problems on others; pathologically jealous
epidimiology of paranoid personality disorder
higher in men than women; higher incidence in family members of schizophrenics
how is paranoid personality disorder diff from paranid schizophrenia?
PPD patients do not have fixed delusions and are not psychotic, although they can have transient psychosis in stressful situations
treatment for paranoid personality disorder
psychotherapy; patients may also benefit from anti-anxiety meds or short course of antipsychotics for transient psychosis
schizoid personality disorder
lifelong pattern of social withdrawal; perceived as eccentric and reclusive; quiet and unsociable with a restricted affect; no desire for close relationships
dsm 4 criteria for schizoid personality disorder
voluntary social withdrawal and restricted range of emotional expression, beginning by early adulthood and present in a variety of contexts; four or more of the following
schizoid personality disorder- four or more of the following
neither enjoying nor desiring close relationships; generally choosing solitary activities; litle interest in sex; taking pleasure in few activities; few close friends; infidd to praise or criticism; emotional coldness, detachment, or flattened affect
epidemiology for schizoid personality disorder
prevalence in men is twice that of women; there is NO incr incidence of schizoid personality disorder in families with schizophrenia
how is schizoid personality disorder different from paranoid schizophrenia
SPD patients do not have any fixed delusions, although these may exist transiently in some patients
his is schizoid personality disorder different from schizotypal personality disorder
typal has eccentric behavior or magical thinking; typal patients are more similar to schizophrenic patients in terms of odd perception, thought, and behavior
treatment for schizoid personality disorder
psychotherapy is treatment of choice; low dose anti-psychotics if transiently psychotic or anti-depressants if comorbid MD is dx
schizotypal personality disorder
a pattern of social deficits marked by eccentric behavior, cognitive or perceptual distortions, and discomfort with close relationships, beginning by early adulthood and present in a variety of contexts
criteria (five or more) for schizotypal personality
ideas of reference (excluding delusions of reference); odd beliefs or magical thinking; unusual perceptual experiences; suspiciousness, inapprop affect; odd appearance; few close friends or confidants; odd thinking or speech; excessive social anxiety
how is schizotypal personality disorder different from paranoid schizophrenia
schizotypal patients do not have fixed delusions and they are not frankly psychotic
how is schizotypal personality disorder difference from schizoid personality disorder
schizoid do not have the same eccentric behavior seen in patients with schizotypal
treatment for schizotypal personality disorder
psychotherapy; short course of low dose antipsychotics if necessary (for transient psychosis)
diagnosis of antisocial personalit disorder
pattern of disregard for others and violation of the rights of others since age 15; patients must be at least 18 years old; three of listed criteria
three listed criteria for antisocial personality disorder
failureto conform to social norms by committing unlawful acts; deceitfulness/manipulating others for personal gain; impulsivity; irritability and aggressiveness; lack of remorse; recklessness; irresponsibility
treatment for antisocial personality disorder
psychotherapy is generally ineffective; dialectical behavior therapy (DBT) and behavioral therapy are the best options
borderline personality disorder
pervasive pattern of impulsivity and unstable relationships, affects, self-image, and behaviors, present by early adulthood and in a variety of contexts. 5 criteria
borderline personality disroder- at least 5 of these criteria
desperate efforts to avoid real or imagined abandonment; unstable interpersonal relationships (love-hate); unstable self image; impulsivity; recurrent suicidal threats; unstable mood/affect; general feeling of emptiness; difficulty controlling anger; transient paranoid ideation
epidemiology for borderline personality disorder
twice as common in women; suicide rate 10%
treatment for BPD
psychotherapy (DBT) is the treatment of choice; pharmacotherapy as necessary
histrionic personality disorder
pattern of excessive emotionality and attention seeking, present by early adulthood and in a variety of contexts; at least five of criteria
criteria for histrionic personality disorder
uncomfortable when not the center of attention; inapprop seductive behavior; uses physical appearance to draw attention; speech is impressionistic and lacking in detail; exaggerated expression of emotion; easily influenced by others or situation; perceives relationships as more intimate than they actually are
treatment for histrionic personality disorder
psychotherapy is treatment of choice; pharmacotherapy as needed for sx
narcissistic personality disorder
pattern of grandiosity, need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts; five criteria must be met
criteria for narcissistic personality disorder
exaggerated sense of self importance; preoccup with fantasies of unlimited money, success, brilliance, etc.; believes that he or she is special; needs excessive admiration; has sense of entitlement; takes advantage of others for self gain; lacks empathy; envious of others or believes others are envious of him; arrogant
narcissistic personality disorder compared to antisocial personality disorder
both types of patients exploit others, but NPD patients want status and recognition, while antisocial patients want material gain or simply the subjugation of others
treatment for narcissistic personality disorder
psychotherapy; group therapy may help these patients learn empathy; antidepressants or lithium may be used as needed
avoidant personality disorder
pattern of social inhibition, hypersens, and feeling of inadequacy since early childhood ; four of the criteria
criteria for avoidant personality disorder
avoids occupation that involves interpersonal contact due to a fear of criticism and rejection; unwilling to interact unless certain of being liked; cautious of interpersonal relationships; believes he or she is socially inept or inferior; reluctant to engage in new activities for fear of embarassment
difference between avoidant personality disorder and schizoid personality disorder
patients with avoidant pers disorder desire companionship but are extremely shy; those with schizoid pers disorder have no desire for companionship
diff between social phobia (SAD) and avoidant personality disorder
if the sx are an integral part of the person’s personality and have been evident since before adulthood, personality disorder is more likely; social phobia is fear of embarassment, whereas APD is fear of rejection and a sense of inadequacy
treatment for avoidant personality disorder
psychotherapy, including assertivesness training, is most effective; bta blockers may be used to control autonomic sx of anx and SSRIs may be prescribed for major depression
dependent personality disorder
pattern of submissive and clnging behavior due to excessive need to be taken care of; at least five of the criteria
criteria for dependent personality disorder
difficulty making veryday decisions without reassurance from others; needs others to assume responsbilities for most areas of her life; cannot express disagreement bc fear of loss of approval; difficulty initiating projects bc of lack of confidence; feels helpless when alone; urgently seeks another relationship when one ends
dependent personality disorder sx tend to decrease with age and/or therapy
right
treatment for dependent personality disorder
psychotherapy, particularly groups and social skills training; pharmacotherapy for assoc sx
OCPD
pattern of preoccupation with orderliness, control, and perfectionism, at the expense of efficiency, present by early adulthood and in a variety of contexts; need at least four of the criteria
OCPD criteria
preoccupation with detalis, rules, lists such that the major pt of the activity is lost; perfectionism that is detrimental to completion of the task; excessive devotion to work; excessive scrupulousness about morals and ethics; will not delegate; unable to discard worthless objects; miserly; rigid and stubborn
gender in OCPD
men more likely than women; occurs most often in the oldest child
differenced between OCD and OCPD
patients with OCPD do not have the recurrent obsessions or compulsions that are present in OCD; the sx of OCPD are ego-syntonic
treatment for OCPD
psychotherapy (group therapy and behavior therapy may be useful)
personality disorder NOS
includes disorders that don’t fall into clusters A, B, or C; examples are passive aggressive PD, depressive PD, sadomasochistic PD, and sadistic PD
passive aggressive PD
patients are stubborn, inefficient procrastinators; they alternate between compliance and defiance and passively resist fulfillment of tasks; lack assertiveness;manipulate others to do their chores
tx for passive aggressive PD
psychotherapy
depressive PD
lifelong traits of depressed-like state; these people are pessimistic, chronically unhappy, and distressed
antisocial personality disorder begins in childhood as what?
conduct disorder
borderline personality disorder patients commonly use what defense mech?
splitting (viewing others as all good or all bad)
pharmacotherapy and PD
pharmacotherapy is more useful in BPD than in any other PD
histrionic patients often use what defense mech?
regression (revert to childlike behaviors); also seen in patients with DPD
