Vertrees Personality disorders Flashcards
What is a Personality disorder
An enduring pattern of inner experience and behavior that deviates from cultural norms
Manifested in 2 of the following ways
- Cognition (perception of self, others, and events)
- Affectivity (range, intensity, stability of emotions)
- Interpersonal functioning (relationships)
- Impulse control
This pattern spans across life arenas and is inflexible
This pattern is stable, long lasting, and goes back to adolescence or early adulthood
Pattern leads to distress and impairment in social and occupational arenas
Not from drugs or a medical/mental illness
personality disorder stats
Roughly 15% of adults have at least one PD
67% of people with one PD have a second
Usually the second is in the same Cluster
Often become less symptomatic as they age but still have some deficits
Cluster A
Paranoid Personality Disorder
2. Schizoid Personality Disorder 3. Schizotypal Personality Disorder
Cluster B
- Antisocial Personality Disorder
- Borderline Personality Disorder
- Histrionic Personality Disorder
- Narcissistic Personality Disorder
Cluster C
- Avoidant Personality Disorder
- Dependent Personality Disorder
- Obsessive-Compulsive Personality
Disorder
Antisocial Personality Disorder
Pattern of disregard for, and violation of, the rights of others since age 15 with evidence of Conduct disorder before.
No concept of social contract
Don’t see self or others as sacred beings
Jungle mentality: “You’re either eating or being eaten.”
They are sorry - for getting caught (which implies stupidity)
Antisocial Criteria
Failure to follow norms/laws, repeated legal violations
Deceitfulness, con artist mentality
Impulsivity, lack of long term planning
Irritability, aggressiveness, assaultiveness
Disregard for safety of self and others
Lack of responsibility, often seen in work or financial obligations
Lack of remorse. Indifferent to having hurt or stolen
Conduct Disorder
Demonstrating behavior in:
Physical aggression or threats of harm
Property destruction, theirs or others
Theft and acts of deceit
Violation of age appropriate rules
conduct disorder- The Core Features
Sense of entitlement Deceit and manipulation Aggressive irritability Poor impulse control Low frustration tolerance Externalization of blame Rationalization
Paranoid Personality Disorder
Pervasive distrust & suspiciousness of others such that their motives are seen as malevolent
They are oriented around “threat”
Seek to control environment and resist other’s control over them.
They project fear and suspicion, which becomes a self fulfilling prophecy
paranoid personality disorder - The Criteria
Suspects others of exploiting/lying/harming
Preoccupied with doubts of others loyalty
Fears confiding because suspects info will be turned against him/her
Reads negative meanings into benign comments
Cannot forgive insults, slight, or injuries
Sees character attacks where there are none
Recurrent unfounded suspicions of infidelity
Schizotypal Personality Disorder
Pattern of social deficits marked by acute discomfort with relationships, perceptual distortions, and eccentric behavior.
Referential ideas, odd or magical thought
Odd speech, affect, and appearance
Social anxiety and isolation from paranoia
Schizotypal Personality criteria
Ideas of reference Odd beliefs or magical thinking affects behavior (ESP, etc) Unusual perceptions (sensing presences) Unusual speech and thought patterns Suspiciousness or paranoid thinking Stiff, rigid affect Odd behavior and appearance Lack of close friends Social anxiety does not diminish with familiarity
Schizoid Personality Disorder
Detachment from social relationships and restricted range of affect
No desire for “belonging” with friends, lovers
Decreased sensory experience
Indifferent, no affective engagement
Do great in solitary occupations
“It’s like there’s a glass wall between him and the rest of us”
Narcissistic Personality
Core features:
- Grandiosity (in self importance, entitlement)
- Need for admiration
- Lack of empathy
Self as Special (They’ll let you know.)
- Ambition leads to accomplishment
Others’ sensitivities don’t really register
- Significant life disruptions
Others serve the importance of self
- Special by association with special people
- Non-specials can validate by being in awe
- — If you cant, then you are not-informed, stupid, or evil
Don’t process or feel other’s mental state
- Poor emotional empathy
Relationships are “one up, one down”, not “togetherness”.
Loss of specialness is annihilation.
- No sense of self value beyond being special
Come to treatment only in dire circumstances
- Impending or actual – marital, job, or money loss
Lot of emotion, its just all negative
Therapy often flounders
- Wind up devaluing the therapist and terminating right after they get a new girlfriend/job/house.
Narcissistic Criteria
Inflated sense of self-importance Preoccupied with success, power, brilliance Believes he/she is unique, and can only be understood by other such persons Requires excessive admiration Entitled Interpersonally exploitative Lacks empathy Envious or thinks others envy him/her Arrogant
Histrionic Personality
Core features
- Excessive emotionality
- Attention seeking
From Latin “histrio” – actor
World is painted in vivid colors, but very broad brushstrokes
Everything is overly- “romantic”
- They only tolerate the fairy tale part of the story
Relationships are exciting but unstable
- Get tired of boredom of developed relationships
- Act out a role (victim or royalty) in relationships
- – Blend dependency with need for drama
- – Suicidal threats/attempts for more focused attention
- Beliefs, interests shift quickly
- Friends may-
- – see them as a threat to their own partnerships
- – Get burned out by the need for attention
Intolerant of delayed gratification
histrionics and treatmen
Come to treatment for “fairy tale burnout”
Group therapy
Can help identify socially inappropriate behaviors
Individual therapy/CBT
Help identify motivations for recurring relationship disaster
Histrionic Personality Criteria
Uncomfortable when not center of attention
Often inappropriately seductive/provocative
Shows quickly shifting and shallow emotions
Usually uses physical appearance to draw attention
Speech is impressionistic and lacks detail
Self-dramatization, exaggerated emotions
Suggestible
Considers relationships more intimate than they really are
Borderline Personality
Core features
- Unstable relationships, self-image, and affect
- Highly impulsive
Core deficit is lack of internal sense of self
- Validity, goodness, lovability are not held inside
- Others are needed to affirm one’s worthiness
Intense fear of being abandoned – being “bad”
- One is never in control of one’s validity
Borderline Personality stats
20-25% of psychiatric inpatients
80% of BPD pts experiences sexual abuse before 18
Self injurious behavior is essentially pathognomonic for BPD
- Cutting blunts emotional pain, atones for “bad”
~10% completed suicide rate
Borderline Personality- splitting and comorbidities
Splitting-
When being validated, the other is pure good
This is idealization
If “abandoned”, the other is evil (“the worst”)
This is devaluation
Splitting is a failure to integrate positive and negative qualities in self and others
Comorbidities PTSD Bulimia DID Substance use Fibromyalgia
Borderline Personality treatment
Treatment – DBT
Mentalize more and cut less
Low dose meds
Antipsychotics help stabilize mood, perception
Antidepressants can help baseline mood
Treat comorbidities
Borderline Personality Criteria
Frantic efforts to avoid abandonment
Pattern of intense but unstable relationships marked by splitting
Unstable sense of self or self-image
Impulsivity in self destructive ways
Recurrent suicidality and self injurious behavior
Affective instability (frequent and sudden)
Chronic feelings of emptiness
Inappropriate, intense anger
Brief paranoid thinking or dissociation under stress
Avoidant personality
Core features
- Pattern of social inhibition
- Feelings of inadequacy
- Hypersensitive to negative evaluation (rejection)
They strongly desire socialization but have low threshold for perceiving criticism
- Contrast this with Schizoid PD
They will avoid the date/interview/job rather than risk ridicule
Avoidant Personality Vicious cycle –
terribly afraid of criticism and their reaction (crying, blushing)
Their fear and tenseness inhibits performance and invites ridicule
Fear is validated
When others can “prove” that they won’t criticize them, then can be friends
Few social connections leads to a certain dependency
Avoidant Personality criteria
Avoids jobs that require much interpersonal contact for fear of criticism, rejection
Unwilling to get involved with others unless certain of being liked
Restrained in intimate relationships for fear of being shamed or ridiculed
Preoccupied with being criticized/ridiculed
Inhibited in new social situations because of feeling inadequate
Views self as socially inept, unappealing, inferior
Extremely reluctant to take personal risks or engage in new activities for fear of embarrassment
Dependent Personality Criteria
Has difficulty making everyday decisions without a lot of advice
Needs others to assume responsibility for major areas of their life
Fears expressing disagreement because of worry of loss of support
Struggles to initiate projects (from lack of confidence, not motivation or energy)
Goes to great lengths to obtain others’ support
Feels uncomfortable/ helpless when alone
Always needs to be in a close relationship
Unrealistically preoccupied with fears of being left alone
Dependent Personality Core features
Excessive need to be taken care of Leads to submissive and clingy behavior Designed to elicit caregiving Arise from belief that they cant function without help Strong fears of separation
Feeling so unable to function alone drives all other behavior (“I’m stupid”)
Notably, they often function adequately if someone is supervising and approves
- But since competence can lead to abandonment, they often avoid learning skills for living
Will tolerate distorted relationships
Will tag along even when errand/task holds no interest or involvement for them
Notably, don’t put much effort into who they are dependent on
Distinguish from life-stage/circumstance dependence
Obsessive compulsive Personality criteria
Preoccupied with rules, lists, details, organization at the expense of the goal
Perfectionism that interferes with completion
Work and productivity exclude leisure and friends
Inflexible in matters of morals, ethics, values
Unable to let go of worn out things even when no sentimental value
Unable to work with others unless they do it “my” way
Stingy with spending, hoards money for catastrophes
Rigid, stubborn
Obsessive Compulsive Personality core features
Core features Control Interactions Mental Environment
Underneath is a lack of confidence in finding one’s own answers
Lack of trust that “things will work out”
how to remember clusters
A- weird
B- wild
C- worried
Just in introducing yourself, you notice an extreme suspiciousness of your motives. He refers to psychiatry as “the Satanic mind control religion” and is concerned with “where are you from?” This leads to governmental conspiracies and how psychiatry is involved. This leads to discussion of his (wildly successful) business, publishing a Soldier of Fortune-esque magazine.
chronic paranoid schizophrenia
Pt Doesn’t bother with co-workers and “their drama.” She flatly admits to never dating, or having any sexual encounters, and seems perfectly fine with this. Kids, pets, friends don’t concern her unless her parents are talking about them. She spends free time reading about, and collecting, South American rocks. Friday nights are fun: she goes to parents’ house for dinner and Scrabble. So does her brother.
Schizoid Personality d/o
doesn’t want to participate and is happy with that
PT always wears a black cape, black boots, and green everything else. Another neighbor tells you that he lives alone, is an overnight sorter at the post office, and seems to have a thing for cats. He once told some kids in the street that they needed to watch out for witches that roam the streets.
Schizotypal Personality disorder
court ordered inpatient rehab after 3rd DUI. You walk in and are greeted by a well-groomed, delightful guy. Good eye contact, nice smile, smart, funny. Great conversation. He explains how he left college because some professor said he plagiarized his final. He doesn’t seem to have detailed life goals.
He states he really wants to get clean, but also seems to be bragging about how much he can drink, and the “crazy things we did” while using. He tells you a funny story of robbing, or “knocking over”, his own cocaine dealer once. He mentions having recently found out he was a father. You ask about his employment plans in order to support the child. He laughs, “What? I am supposed to get a job because she forgets to take her birth control pill?!”
Finally, you mention that staff claim he stole a peer’s ring last night. He looks you right in the eye and indignantly denies it. You point out that the facility has security cameras. He points out that cameras aren’t going to show anything with the lights out. You point out they are infra-red cameras. Finally, Josh glibly admits he took the ring, but points out “it’s his fault for leaving it lying around, if I didn’t take it, someone else would have.”
antisocial
You sit down to meet Kyle, a patient on your eating disorders unit. Kyle is 22, a junior in music theory and philosophy at Penn, and is on the cross country team. He is fairly vague about his aspirations other than a desire “to write music that means something.” He describes starting binging and purging at the age of 17 to help counter feelings of loss of control over his life. He notes that he often binges in times of social upset.
Kyle’s seems to have a strained relationship with his upper middle class parents. He feels that they are too controlling and intrusive. Yet he is quite distressed if his mother forgets to call him daily or if they fail to answer even one phone call of his. Both situations cause him to feel “they don’t care.” He identifies as bisexual, which, “of course, they don’t get.”
You notice that Kyle socializes well with peers. He laughs and jokes a lot. But staff note his mood can quickly shift and he can become quite despondent. He describes that since adolescence he usually feels restless and “blue”, but that he can “put on a smile.” However, he states that if he has a disagreement or disappointment, or even for no reason at all, his mood can instantly bottom out for hours. He states he has thoughts of being dead multiple times a day.
Borderline Personality disorder
guy drops names, compares where his kids are going to school, blathers about his expensive vacation.
calls later and says he needs an appt because his wife is leaving him
gets treatment for a while but then gets involved with a new gal
narcissistic personality disorder
