Trastornos de Personalidad Flashcards
19.1.
Which personality disorder is associated with traits of chronic
social withdrawal and isolation, along with discomfort with
interacting with others and a constricted affect?
A. Antisocial
B. Avoidant
C. Paranoid
D. Schizoid
E. Schizotypal
19.1. D. Schizoid
Schizoid personality disorder is characterized by lifelong social
withdrawal, and they are often described as eccentric. They have
discomfort with interacting with others and a bland, constricted
affect is noted on mental status examination. In contrast, those with
avoidant personality disorder are also socially withdrawn but they
are not asocial and show a great desire for companionship and are
very sensitive to rejection. Antisocial personality disorder is
characterized by lack of ability to conform to social norms and can
include criminal acts. Those with paranoid personality disorder are
often mistrustful, hostile, and irritable. Those with schizotypal
personality disorder often have magical thinking and ideas of
reference and derealization.
19.2.
Criticism of the DSM-5 personality disorder diagnoses
include which of the following concerns?
A. A categorical approach is used
B. An approach based on temperament is utilized
C. Comorbid substance use and other medical illnesses are not
accounted for
D. Impairment is limited to only a focus on dysfunctional
relationships
E. The focus is on a dimensional approach
19.2. A. A categorical approach is used
The categorical approach to personality disorders in DSM-5 is
thought to be problematic to describe complex personality disorders
in a few symptoms. A dimensional approach is better supported by
research, incorporating temperament and functional impairment
19.3.
On mental status examination, a patient has thought content
significant for projection, themes of jealousy, and ideas of
reference. The patient’s speech is goal-directed and logical,
with no signs of psychosis, and motor is significant for tension.
Which of the following personality disorders best fits this
description?
A. Avoidant
B. Dependent
C. Obsessive compulsive
D. Paranoid
E. Schizotypal
19.3. D. Paranoid
Those with paranoid personality disorder present as formal and
tense on mental status examination and often have a humorless
mannerism. Speech is often goal-directed and logical though thought
content shows evidence or projection and often ideas of reference. A
patient with schizotypal personality disorder often presents as
inappropriate with psychotic symptoms. Avoidant personality
disorder presents as an anxious patient with a tense manner, along
with vulnerability to the interviewer’s comments, feeling criticized at
times. A patient with dependent personality disorder often presents
as complaint and often looks for guidance. Obsessive compulsive
personality disorder is notable for a stiff demeanor, constricted affect
with a serious mood, and defense mechanism of rationalization,
isolation, intellectualization, and undoing are utilized.
19.4.
Which personality disorder is classified under a psychotic
disorder, rather than personality disorder in the international
classification of diseases, Tenth revision (ICD-10)?
A. Antisocial
B. Borderline
C. Paranoid
D. Schizoid
E. Schizotypal
19.4. E. Schizotypal
Schizotypal personality disorder is characterized by pervasive
discomfort with an inability to maintain close relationships. It
presents with eccentric behavior, and oddities in thinking and
appearance. These patients may have peculiar speech and express
superstitious thoughts, thinking they possess special powers and can
present as having brief psychotic symptoms at times. In ICD-10
schizotypal personality disorder is classified under psychotic
disorders, rather than personality disorder
19.5.
A patient presents as having lifelong stormy relationship and
is always in a state of crisis. The patient has struggled with
self-harm and feelings of anger, alternating with numbness
and emptiness. This patient is most likely to use which of the
following defense mechanisms?
A. Intellectualization
B. Isolation
C. Projective identification
D. Rationalization
E. Reaction formation
19.5. C. Projective identification
The patient described above most likely has borderline personality
disorder. Patients with this disorder can present as argumentative
and have episodes of psychosis and depression with unpredictable,
self-destructive behavior, including self-harm. Feelings of anger,
numbness, loneliness, and emptiness are characteristic of this
disorder. Projective identification, in which the patient projects their
own intolerable aspects of themselves onto others, is a classic
defense mechanism for this disorder
19.6.
A patient presents as attention-seeking and as emotionally
labile and hypersexual or flirtatious at times. Which of the
following defense mechanics is most likely to be utilized by
this patient?
A. Dissociation
B. Intellectualization
C. Projection
D. Reaction formation
E. Sublimation
19.6. A. Dissociation
The patient described above has histrionic personality disorder.
Traits include attention-seeking behavior along with seductive
behavior. They can present as suggestible and emotionally labile. The
major defenses these patients utilize are dissociation and repression
19.7.
Which personality disorder is only included in DSM-5 and in
ICD-10 is listed under an “other specific personality disorder”?
A. Borderline
B. Dependent
C. Histrionic
D. Narcissistic
E. Paranoid
19.7. D. Narcissistic
In DSM-5, narcissistic personality disorder is defined as those
persons with a grandiose sense of self-importance, characterized by
strained relationships, often exploiting others, lacking empathy,
jealousy, and having a fragile self-esteem. In the ICD-10, it is not
included as a separate personality disorder, rather it is listed under
an “other specified personality disorder.”
19.9.
Which of the following symptoms is a distinguishing factor
between schizophrenia versus paranoid personality disorder?
A. Hallucinations
B. Hostile or threatening demeanor
C. Ideas of reference
D. Jealousness
E. Suspiciousness
19.9. A. Hallucinations
Paranoid personality disorder differs from schizophrenia in that no
hallucinations or formal thought disorders are noted. All of the other
features mentioned above can be symptoms of either schizophrenia
or a paranoid personality disorder
19.8.
Which personality disorder in ICD-10 is defined by excessive
attention to detail and checking behaviors, along with
rigidness and self-doubt?
A. Anankastic
B. Avoidant
C. Borderline
D. Dependent
E. Not otherwise specified
19.8. A. Anankastic
Anankastic personality disorder is the ICD-10 term for obsessive
compulsive personality disorder. Features include those mentioned
about included self-doubt, perfectionism, checking, attention to
detail, stubbornness, being overly cautious, and having unwanted
thoughts of impulses
19.10.
Which of the following symptoms are more commonly found
in borderline personality disorder, as compared to histrionic
personality disorder?
A. Egocentrism
B. Exaggerated speech and emotions
C. Flirtations and being sexually provocative
D. Identity diffusion
E. Somatic symptoms
19.10. D. Identify diffusion
Though features of borderline and histrionic personality disorders
overlap, identity diffusion, suicide attempts, and brief psychotic
episodes are more common in borderline personality disorder
19.11.
A patient with chronic self-esteem issues and a fear of
loneliness and abandonment calls her one friend daily and
will only go out with her. She needs to call her to ask her
opinion of trivial things daily and struggles with making any
decisions on her own. The friend describes her as
kindhearted and has not had any recent arguments with her.
Which is the most likely personality disorder this patient
has?
A. Dependent
B. Borderline
C. Histrionic
D. Obsessive compulsive
E. Schizoid
19.11. A. Dependent
Dependent traits can occur in many psychiatric disorders, including
both histrionic and borderline personality disorders, as well as
dependent personality disorder. With dependent personality
disorder, the person usually has a long relationship with one person.
In contrast, with borderline and histrionic personality disorders, a
series of tumultuous relationships are seen.
19.12.
A patient presents with chronic fears of being disliked by
others and avoids relationships due to fears of shame,
rejection, and criticism by others. Which of the following
personality disorders is most commonly comorbid with this
one?
A. Antisocial
B. Histrionic
C. Narcissistic
D. Obsessive compulsive
E. Schizoid
19.12. A. Schizoid
The patient described above has avoidant personality disorder.
Paranoid, schizotypal, schizoid, dependent, and borderline are the
most commonly co-occurring personality disorder with avoidant
personality disorder.
19.13.
Which is the most likely course of borderline personality
disorder?
A. Completed suicide in the fifth decade of life
B. Development of a comorbid psychotic disorder by one’s fifth
decade
C. Functional improvement is noted by the second decade in
life
D. History of multiple arrests by the time one reaches their 20s
E. Greater relationship stability is achieved in one’s 40s and
50s
19.13. E. Greater relationship stability is achieved in one’s
40s and 50s
Functional improvement in borderline personality disorder is often
not noted until the fourth and fifth decades of life. While brief
psychotic episodes can be a component of borderline personality
disorder, comorbid psychotic disorders are rare. While death from
suicide is a risk of this disorder, the suicide and self-harm risks are
highest in the young adult years and wane as time goes on. A history
of multiple arrests is more common with antisocial personality
disorder.
19.14.
Which type of psychotherapy is best suited toward patients
with antisocial personality disorder?
A. Contingency management
B. Dialectical behavioral therapy
C. Group therapy
D. Psychodynamic psychotherapy
E. Social skills training
19.14. A. Contingency management
Those with antisocial personality disorder are thought to have a
limited response to therapy. A limited evidence base supports that
these patients repose better to contingency management and
rewards-based interventions, compared to cognitive behavioral
therapy.
19.15.
Which is an important component of dialectical behavioral
therapy in treating patients with borderline personality
disorder?
A. Contingency management
B. Mentalization training
C. Phone consultation
D. Reliance on clarification
E. Use of confrontation
19.15. B. Phone consultation
Dialectical behavioral therapy has the most empirical support for
treating borderline personality disorder. It involves utilizing four
modalities: group skill training, individual therapy, phone
consultation, and a consultation team. Contingency management is
useful for treating antisocial personality disorder. Mentalizationbased
therapy (MBT) is another type of therapy used to treat
borderline personality disorder, as is transference-focused
psychotherapy (TFP), in which the therapy relies on the use of
clarification and confrontation in working with the patient using a
psychodynamic approach.
