1. Antisocial Personality Disorder 2. Borderline Personality Disorder 3. Histrionic Personality Disorder 4. Narcissistic Personality Disorder

1. Avoidant Personality Disorder 2. Dependent Personality Disorder 3. Obsessive-Compulsive Personality Disorder

Vertrees Personality disorders Flashcards by Briana Tillman

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

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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

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Cluster A

Paranoid Personality Disorder

  2. Schizoid Personality Disorder 
  3. Schizotypal Personality Disorder

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Cluster B

Antisocial Personality Disorder
1. Borderline Personality Disorder
2. Histrionic Personality Disorder
3. Narcissistic Personality Disorder

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Cluster C

Avoidant Personality Disorder
1. Dependent Personality Disorder
2. Obsessive-Compulsive Personality
  Disorder

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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)

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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

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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

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conduct disorder- The Core Features

Sense of entitlement
Deceit and manipulation
Aggressive irritability
Poor impulse control
Low frustration tolerance
Externalization of blame
Rationalization

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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

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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

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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

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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

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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”

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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.

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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