Vertrees Personality disorders

Question 1

What is a Personality disorder

Answer 1

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

Question 2

personality disorder stats

Answer 2

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

Question 3

Cluster A

Answer 3

Paranoid Personality Disorder

  2. Schizoid Personality Disorder 
  3. Schizotypal Personality Disorder

Question 4

Cluster B

Answer 4

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

Question 5

Cluster C

Answer 5

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

Question 6

Antisocial Personality Disorder

Answer 6

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)

Question 7

Antisocial Criteria

Answer 7

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

Question 8

Conduct Disorder

Answer 8

Demonstrating behavior in:

Physical aggression or threats of harm
Property destruction, theirs or others
Theft and acts of deceit
Violation of age appropriate rules

Question 9

conduct disorder- The Core Features

Answer 9

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

Question 10

Paranoid Personality Disorder

Answer 10

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

Question 11

paranoid personality disorder - The Criteria

Answer 11

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

Question 12

Schizotypal Personality Disorder

Answer 12

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

Question 13

Schizotypal Personality criteria

Answer 13

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

Question 14

Schizoid Personality Disorder

Answer 14

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”

Question 15

Narcissistic Personality

Answer 15

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.

Question 16

Narcissistic Criteria

Answer 16

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

Question 17

Histrionic Personality

Answer 17

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

Question 18

histrionics and treatmen

Answer 18

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

Question 19

Histrionic Personality Criteria

Answer 19

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

Question 20

Borderline Personality

Answer 20

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

Question 21

Borderline Personality stats

Answer 21

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

Question 22

Borderline Personality- splitting and comorbidities

Answer 22

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

Question 23

Borderline Personality treatment

Answer 23

Treatment – DBT
Mentalize more and cut less

Low dose meds
Antipsychotics help stabilize mood, perception
Antidepressants can help baseline mood
Treat comorbidities

Question 24

Borderline Personality Criteria

Answer 24

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

Question 25

Avoidant personality

Answer 25

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

Question 26

Avoidant Personality Vicious cycle –

Answer 26

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

Question 27

Avoidant Personality criteria

Answer 27

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

Question 28

Dependent Personality Criteria

Answer 28

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

Question 29

Dependent Personality Core features

Answer 29

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

Question 30

Obsessive compulsive Personality criteria

Answer 30

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

Question 31

Obsessive Compulsive Personality core features

Answer 31

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”

Question 32

how to remember clusters

Answer 32

A- weird
B- wild
C- worried

Question 33

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.

Answer 33

chronic paranoid schizophrenia

Question 34

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.

Answer 34

Schizoid Personality d/o

doesn’t want to participate and is happy with that

Question 35

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.

Answer 35

Schizotypal Personality disorder

Question 36

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.”

Answer 36

antisocial

Question 37

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.

Answer 37

Borderline Personality disorder

Question 38

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

Answer 38

narcissistic personality disorder