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personality disorder def

Enduring pattern (“pt always been this way”) of behavior that deviates from the patient’s CULTURE.

-Pattern manifests in 2 or more areas of functioning such as cognitive, affectivity, interpersonal functioning or impulse control.

1st Aid: CAPRI (cognitive, affect, personal relations, impulse)


3 clusters

Cluster A: Odd or Eccentric
-paranoid, schizoid, schizotypal

Cluster B: Dramatic, Erratic or Emotional
-borderline, histrionic, antisocial, narcissistic

Cluster C: Anxious or Fearful
-Avoidant, OCPD, Dependent


cluster A disorders

A-Paranoid: suspicious of other people. Assume motives are hostile when benign. Look for hidden messages.

A-Schizoid: “loners” do not enjoy social relationships. Constricted affect. Prefer solitary tasks. Okay alone.

A-Schizotypal: “loners” w/magical beliefs, have eccentric thoughts and behaviors, may be disordered in thinking


cluster b

B-Borderline: intense relationships, black & white thinking, “splitting” as defense mech, may have hx of sexual abuse/trauma.

B-Narcissistic: grandiose view, want to be admired, superiority complex, VERY sensitive to critique.
-Become depressed when don’t get recognition they deserve.

B-Antisocial: disregard rights of others, lack empathy or feelings of guilt. Generally some aspect before age 15. Often w/substance abuse history & legal problems.
-hx of behavior like this in a child may suggest conduct disorder

B-Histrionic: dramatic & attention-seeking behavior. Theatrical. Draws attention to self. Superficial & seductive.


cluster c

C-Avoidant: fears rejection or criticism. Hyperaware of cues that may mean they are being mocked or criticized.

C-Dependent: rely on others, submissive, clingy behavior. Will agree to avoid abandonment.

C-OCPD: more “perfectionism” than true OCD. Pts are inflexible, bothered by routine changes, need to be in control of situations, are upset when not in control.


Which PD has an increased correspondence with childhood
Sexual trauma or abuse?



Which cluster of PD has a familial association with psychotic disorders?

cluster A


Which PD has been shown to be most successfully treated with drugs?



Which PD uses the defense mechanism of regression?



How is social phobia different from Avoidant PD?

Social phobia-fear of embarrassment in particular setting like public speaking, using public restroom, eating in public

Avoidant PD-fear of rejection with sense of inadequacy


What are some risk factors for OCPD?

Men>>Women; First-born child
-remember OCPD is ego-syntonic, pts are motivated by work and feel that they are more devoted to work than others. They are not efficient and will not delegate tasks.


In Keye’s study of healthy men who were starved,
What symptoms did they develop? What % never recovered?

Symptoms=moody, loss of humor, preoccupation with food, discussion of recipes, group solidarity, decreased decision making.
20% were permanently psychologically hurt and never recovered.


What are the subtypes of anorexia nervosa?

Restricting and Binge-Purge Types


What are some risks for AN?

Females, Genetics, Obstetrical complications, Dieting, Athletes (disordered eating, amenorrhea and osteoporosis


What is the DSM definition of bulimia nervosa?

Binge eating (large amounts or a sense of lack of control), with recurrent compensatory behavior (purging, laxatives, over-exercising, pills, restricting), both occur 2x week for over 3 months.


Are genetics more a risk factor in AN or BN?



What cathartic can cause heart enlargement & cardiac toxicity?

Syrup of Ipecac


What are the four main causes of death in eating disorders?

Starvation, Cardiac Arrhythmia, Suicide, Gastric Dilatation/Rupture

-eating disorders have the highest death rate

-about 10% of ED pts will die from d/o directly (above)


What is the most common Axis I comorbidity in both AN & BN?

MDD or Dysthymia (50-60% of patients)


Which disorder does` better on psych meds, AN or BN?

Bulimia—SSRI’s all show ability to reduce binging behaviors; have 50% reduction in symptoms (but not an elimination of symptoms)

-note that CBT is FIRST LINE Tm in BN, not meds

-note best Tm in AN is Family Therapy, best if pt is <21 years old.


What is the diagnosis if patients have recurrent binges, 2x/week
Over period of 6 months with marked distress over the binging?

Binge-Eating Disorder.
-No purging behaviors
-pts eat alone 2/2 embarrassment, eat when not hungry
-Men=Women, onset in middle adult years


Even after AN patients return to a normal weight, are they still
At risk for fertility and pregnancy complications?

Yes-reproductive rates are diminished-higher rate of pregnancy complications even if at normal weight!


What are the axes each for?

Axis I-DSM IV disorders
Axis II-Personality Disorders & mental retardation
Axis III-General Medical
Axis IV-psychosocial & environmental
Axis V-Global assessment of fxn


What sort of gain is sought in factitious disorder?

PRIMARY gain=patient wants to be in sick role & cared for, intentionally produce complaints.
-pts often will have undergone multiple medical procedures
-pts often work in medical field or family does

-note that malingering is for SECONDARY gain


What are two strong predictors of violence?

EtOH intoxication and an overt stressor (breakup, loss)
-Males ages 15-24 most likely to be violent
-Low socioeconomic status, poor social support


What sort of disorder is it when a patient expresses feelings unintentionally
And unconsciously through a metaphorical body dysfunction?
(feelings of hitting pt’s mom→paralysis of pts right arm)

Conversion disorder
-dramatic sudden development of neurologic symptoms not associated with usual signs and test results expected
-Similar to conversion d/o, somatization is also unconscious and unintentional