Psych - Personality Disorders Flashcards
Personality
Comprised of both biological hard-wiring (temperament) and environmental influences (our character)
Assessed by Myers-Briggs and Costa and McCrae
MB has four dimensions – extra/introversion, realism/idealism, analyzing/sympathizing, control/spontaneity
CM has five dimensions – openness, conscientiousness, extraversion, agreeableness, neuroticism (OCEAN)
Personality disorders
Patients have an INFLEXIBLE problem with how they perceive the world, regulate emotions or impulses, or interact with others that deviates significantly from cultural norms
Overall prevalence is approximately 15%, each disorder has about a 0.5-2% prevalence
Prevalence much higher among Axis I patients (treatable, psychiatric disorders)
During a depressive/manic/any other axis 1 episode/major life event it is VERY DIFFICULT TO DIAGNOSE a personality disorder
Cluster A Personality Disorders
The “odd” personality disorders
PARANOID PERSONALITY DISORDER = patients have a PERVASIVE DISTRUST, but will be absent of any delusions (guy who THINKS FBI is after him qualifies, guy who thinks FBI planted a chip on his face is not)
SCHIZOID PERSONALITY DISORDER – patients present with DETACHMENT from and DERIVE LITTLE PLEASURE FROM SOCIAL SITUATIONS
SCHIZOTYPAL PERSONALITY DISORDER –> patients present with ODD beliefs and affect in addition to schizoid-like symptoms
Cluster B Personality Disorders - Antisocial Disorder
Much more worrisome class of disorders and emotion; dramatic, emotional, erratic
ANTISOCIAL PERSONALITY DISORDER – literally meaning “against society” not aversion to social interactions –> lifelong disorder, and will be seen in CONDUCT PROBLEMS prior to age 15, LAW-BREAKING, problems with IMPULSE CONTROL, and a lack of remorse
More prevalent among men and CRIMINALS; not everyone is a criminal, however
Cluster B – Borderline Personality Disorder
On the “border” between psychosis and neurosis
75% are women
HARMFUL impulsivity and recurrent SUICIDE ATTEMPTS, poorly controlled anger, and transient psychosis/dissociation
Labeled as AXIS II - lifelong illness
BUT, harmful symptoms seen to decrease over time (up to 20% had complete remission of symptoms after 10 years)
Cluster B – Narcissism and Histrionic
These are for the most part TRAITS rather than disorders
Narcissism – a sense of grandiosity, usually rooted in poor self-esteem and a sense of entitlement
Becomes MALIGNANT narcissism - when the patient is also EXPLOITING OTHERS in order to maintain his sense of self-superiority
VAST majority are men
Histrionic patient –> DEMANDING OF ATTENTION and is the classic seductive personality for patients
Cluster C
Disorders characterized by anxiety or fear
AVOIDANT personality Disorder –> characterized by AVOIDANCE of intimacy and social involvement; due to a FEAR OF CRITICISM or EMBARRASSMENT (unlike Schizoid which is just lack of pleasure from it)
DEPENDENT personality disorder – dependence on others to make decisions
OBSESSIVE-COMPULSIVE PERSONALITY DISORDER (this is NOT THE SAME AS OCD) –> presents as a PREOCCUPATION with details, orderliness and perfection –> these urges are NOT in opposition with their personality so they do not cause great distress (unlike in OCD)
Genetics and Personality Disorders
Definitely some genetic correlation, shocker
Among twin studies, heritability estimates are approximately 40-50%
Schizotypal (type A) is more common among 1st degree relatives of individuals with schizophrenia
There are LOW LEVELS of 5-HIAA (serotonin metabolite) in impulsive individuals
Altered brain activity/volume (reduced pre-frontal gray) in antisocial personality disorder
Increased amygdala activity in borderline
Developmental Factors associated with Personality Disorders
Child abuse!!! Associated with borderline!
Pushy parents trying to make their kid something he’s not contributes to NARCISSISM
Treatment of Personality Disorders
MANAGE COUNTERTRANSFERENCE –> in working with these patients, it is absolutely VITAL to acknowledge our own emotions and not let them drive how we interact with these patients!!
PSYCHOTHERAPY is first line in the management of severe personality disorders, with CBT being the most effective and interpersonal (working with relationships) and psychodynamic as needed
Pharmacotherapy is effective for particular symptoms –> SSRI for mood, Antipsychotics for psychotic symptoms (Borderline)
