18. Personality Disorders

Question 1

What is a personality disorder?

Answer 1

Fixed, rigid pattern of behavior and way of acting in the environment that causes distressess and impaired funcitoning.

Question 2

In personality disorders,

1. ​Is the person aware of the problem?
2. When do they usually present?
3. Diagnosing personality disorders in elderly is…

Answer 2

1. No
2. Early adulthood (not dx until 18 YO): generally not diagnosed in children and adolescents because personality is not fully developed and some traits may go away in adulthood.
3. Unreliable: may be due to medical condition/dementia

Question 3

What are the 3 clusters of personality disorder

Answer 3

1. Cluster A (weird; odd or eccentric)
2. Cluster B (Bad; dramatic, erratic or emotional behavior)
3. Cluster C (anxious or fearful behavior)

Question 4

Cluster A (Weird; odd or eccentric behavior) PD

Answer 4

1. Paranoid PD
2. Schizoid PD
3. Schizotypal PD

Question 5

Cluster B (Bad; dramatic, erratic or emotional behavior) PD

Answer 5

1. Antisocial PD
2. Borderline PD
3. Histrionic PD
4. Narcisstic PD

Question 6

Cluster C (Anxious or fearful) PD

Answer 6

1. Obsessive Compulsive PD
2. Avoidant PD
3. Dependent PD

Question 7

Paranoid Personality Disorder

Answer 7

Suspicious and distrust of thers, even friends and family.

1. • think others are exploiting/deceiving you
2. • hidden meanings in comments/events
3. • hard time building relationships: think spouse or partner is cheating

Question 8

Person with Paranoid Personality Disorder is at risk for having what?

Answer 8

1. Agoraphobia
2. Major depression
3. OCD
4. Substance abuse

Question 9

Halmark ego defense of someone with Paranoid Personality Disorder

Answer 9

Projection: attribute unacceptable thoughts to others; accue others of being suspcisiou

Question 10

Schzoid Personality Disorder

Answer 10

• Chooses social isolation; more comfortable alone
• Thinks close relationships are pointless: no close friends
• Flat affect: indifferent to praise or critisism
• No hobbies

Question 11

Person comes to hospital with uncontrolled illness: lives alone, no kids, same job for 35 years. Goes from work => home, repeat and is COMPLETELY OKAY WITH IT.

Answer 11

Schizoid Personality Disorder

Question 12

Schizotypal Personality Disorder

Answer 12

Fear of social interaction and few close friends (does not go away with familiarity) + odd beliefs/thinking

• Ideas of reference: think everything is related to them (think they’re center of ATN)
• Superstitions, telepathy, 6th sense
• KEY = open to challenging beliefs (not fixed = diff from delusions)

Question 13

What makes the odd beliefs in Schizotypal Disorder different from delusions?

Answer 13

• Beliefs are NOT fixed. They are open to challenging them.

Question 14

CLUSTER B

• Antisocial Personality Disorder

Answer 14

1. Disregard for the law and rights of others
2. Aggressive, pervasive lying and deception
3. NO remorse
4. Irresponsible in work and family

Question 15

In order to be diagnosed with Antisocial Personality Disorder, what criteria must you meet.

Answer 15

1. > 18 YO
2. Must have had conduct disorder before 15 YO

Question 16

What is the child form of Antisocial Personality Disorder

Answer 16

Conduct disorder (< 18YO)

Question 17

Antisocial Personality Disorder

1. MC in:
2. At risk for developing what?

Answer 17

1. M
2. At risk for getting
   
   1. Anxiety disorders
   2. Substance abuse
   3. Somatozation disorder
   4. Gambling

Question 18

Borderline Personality Disorder

Answer 18

1. Unstable relationships (Attached, fear of abandonment): “all people are very good or bad: boyfiriend is the BEST/devil”
2. Mood swings (v bad anger)
3. Chronic feeling of emptyiness
4. Impulsive in at least 2 areas that are self-damaging (sex, substance abuse, reckless driving)
5. Manipulative
6. Immature personality traits: teddy bear sign or tweety bird sign
7. Paranoia/dissoaciation

Question 19

Borderline Personality Disorder:

1. Patients are at increased risk for:
2. BPD is often triggered by what?
3. High rate of what comorbidities??

Answer 19

1. Suicide (due to fear of abandoment: ill kill myself bc you dont care) or self mutilation
2. Sexual/emotional abuse
3. Major deppresion

Question 20

When treating patients with BPD, be sure to do what?

Answer 20

Set rigid boundaries:

• 1. constantly remind them of guidelines and respsonsbilities
• 2. Will often “split” staff members/docs against each other.

Question 21

Hallmark defense mechanism in Borderline Personality Disorder

Answer 21

Splitting: black and white thinking, cannot hold opposing views, doc is either great/terrible, all things in world are amazing/terrible

Question 22

What is the gold standard treatment for Borderline Personality Disorder?

Answer 22

1. Dialectical Behavioral Therapy (Type of CBT):
   
   1. Treats chronic suicidality by developing coping skills to improve affective stability and impulse.
   2. Weekly therapy for 1-2 years

Question 23

Histrionic Personality Disorder

Answer 23

• Examples= celebrities

1. Wants to be center of attention (talks loudly, wild stories, hand gestures) and excessive emotions
2. Dramatic, sexually provacoative, seductive (wears sexy clothes, touches others alot)
3. Very concerned with physical apperance
4. La belle indifference: person is unconcerned w sx

Question 24

Narcissistic Personality Disorder

Answer 24

1. Preoccupied with self/ self-inflated and how they’re perceived by others,
2. But envious of others
3. Entitled
4. Lack of empathy for others
5. “Me first personality”

Question 25

**_Narcisstic Personality Disorder_** 1. MC in: \_\_\_. 2. At risk for what?

Answer 25

1. **Male** 2. At risk for: 1. **Anorexia** 2. **Substance abuse** 3. **Depression**

Question 26

**Avoidant** Personality Disorder

Answer 26

1. **Avoids social interactions**/"social inhibition" **but wants them** because they feel inadequate, ppl wont like them. 2. Struggles with intimate relationships

Question 27

How is **Avoidant** and **Schizoid** **Personality Disorder** different?

Answer 27

1. **Avoidant** = wants social interactions and not odd, but cant; 2. **Schizoid** = prefers to be alone

Question 28

**Dependent Personality Disorder**

Answer 28

**Dependent** on others (always in relationships and hard to make decisions on own) 1. **Clingy**; helpless when alone 2. **Low self-confidence,** making it hard to engage in activities 3. **Need others to assume responsibility** for major life events 4. **Hard time expressing opinion**

Question 29

**Obsessive Compulsive Personality Disorder**

Answer 29

1. EX. CEO of company "my way or highway" 2. Preoccupied with **perfection** and **control**"loves to-do lists/always needs a plan" 3. **Inflexible and stubborn**: my way or highway 4. **Even though focused, interferes with efficiency in tasks**

Question 30

How is **OCD** different from **OCPD**?

Answer 30

In **OCPD**, 1. MC in **M** 2. **Behaviors help to acheieve goals: obsessions and compulsions help to acheive goals (ego-syntonic)** 3. **Not aware of problem**

Question 31

**Dissociative Identity Disorder**

Answer 31

1. Presence o**f 2 or more distinct personalities** with own thoughts, behaviors and memory. 2. May **lose track of time** 3. Reported by others/or self 4. Often caused by **history of sexual abuse.**

Question 32

What is **Psychodynamic Psychotherapy?** ## Footnote **How often to you go?**

Answer 32

* Looks at how people perceive events and themselves with the assumption that they are **shaped by early life.** * Finds more adaptive modes of perception and response using **transference**. * Go: several times a week - month *

Question 33

What is **CBT**? How often to you go?

Answer 33

Deals with how people think about world and their perception of it: turns (-) thoughts into (+). Go: 1x week for 6-20 weeks.

Question 34

Can meds cure Personality Disorders?

Answer 34

* **No meds cure personality disorder**: you can use with psychotherapy so that person engages in therapy.

Question 35

Which **antidepressants** should you avoid/prescribe in Personality Disorder?

Answer 35

Avoid: TCAs and MAO-I Give: SSRI and newer drugs; but rmber drugs will be less effective

Question 36

Give _____ to **control impulse** in person with personality disorder.

Answer 36

Valproic acid

Question 37

Give ______ to reduce transient psychotic symptoms, sometimes een in BPD.

Answer 37

**Atypical antipsychotics**

Question 38

Always be concerned about _____ in ppl with Personality Disorders

Answer 38

1. **Suicide** 2. **Avoid benzos/narcotics**

Question 39

Complications of Personality Disorder

Answer 39

1. **Suicide** 2. **Substance abuse** 3. **Accidental injury** 4. **Depression** 5. **Homicide** (esp high in _paranoid_ and a_ntisocial personality disorder_)

Question 40

* Cluster ___ PD gets **worse** later in life * Clusters _____ PD tend to become **less severe and less intense** in middle-age/later life.

Answer 40

* Cluster C = worse * Cluster A/B = gets better

Question 41

Which cluster has the **WORST** prognosis?

Answer 41

**Cluster B** * Susceptible to **substance abuse** * **May die early due to**: impulse control and suicidal behavior.