9B. Personality disorders: diagnostic criteria (clusters a-b-c) and clinical management

Question 1

Personality disorders DEFINITION

Answer 1

are pervasive, inflexible, and maladaptive personality patterns

that lead to significant distress and/or functional impairment.
Deviates from exprectations of an individuals culture

Question 2

Age of onset of personality disorders

Answer 2

late childhood or adolescence

Question 3

personality disorders and which gender they are most common in

Answer 3

Male individuals:
* antisocial (Severe, impairing)
* narcissistic personality disorders
* paranoid
* schizoid
* avoidant
* OCPD

Female individuals:
* borderline personality disorders (Severe, impairing)
* histrionic
* dependent PD

Question 4

which personality disorders are severely impairing

Answer 4

• Antisocial PD (male) - incarcerated or hospitalized
• Borderline personality disorder (common in females) - unemployed, socially isolated

Question 5

which personality disorders are less impairing, patient can maintain job

Answer 5

• Histrionic
• Narcissistic PD

patients have difficulty maintaining social relationship

Question 6

Etiology of Personality disorder

Answer 6

• Multifactorial
• Combination of
  1. hereditary
  2. psychosocial factors (e.g., child neglect, abuse

Question 7

DSM 5 criteria of personality disorders

Answer 7

Question 8

cluster A personality disorders

Answer 8

• Paranoid
• schizoid
• schizotypal PD

Question 9

Cluster A personality disorders characteristic behavior

Answer 9

“Weird”

• odd
• eccentric
• unable to form close interpersonal relationships
• typically: no psychosis

Question 10

cluster A PD are commonly associated with which condition

Answer 10

psychotic disorders ( eg schizophrenia)

PaSS

Question 11

Cluster B personality disorders

Answer 11

Antisocial
Borderline
Histrionic
Narcissistic

BANHed

Question 12

Cluster B personality disorders characteristic behavior

Answer 12

“wild”

• Dramatic
• emotional
• Unpredictable/ inconsistent

Question 13

cluster b commonly associated with

Answer 13

• mood disorders
• recreational drug use

Question 14

Cluster C personality disorders

Answer 14

• Avoidant
• Dependent
• Obsessive-compulsive PD

DOA

Question 15

Cluster C personality disorders characteristic behavior

Answer 15

• fearful
• avoidant
• anxious

Question 16

Cluster C personality disorders associated with

Answer 16

anxiety disorders

Question 17

Clinical features common to all personality disorders

Answer 17

*Affected individuals consider their symptoms normal and nonproblematic
*Thinking and behavior that significantly differ from cultural expectations

Question 18

Treatment of personality disorders

Answer 18

• Psychotherapy, dialectical behavior therapy, group therapy, and/or cognitive therapy
• Medical therapy (for symptomatic relief)

o Mood stabilizers: valproate, topamirate, and lamotrigine
▪Decrease symptoms such as affective dysregulation, impulsivity, and aggression

o Antipsychotics: for symptoms of delusion
o Antidepressants: SSRIs

Question 19

Paranoid personality disorder diagnostic criteria

Answer 19

▪At least 4 of the following criteria must be met
*Pervasive distrust of others
*Unjustified fear that others will use information against them
*Unjustified suspicion about the loyalty of friends and family
*Unjustified suspicion that others are deceiving or harming them
*Suspicions of infidelity in sexual partners/spouse
*Disproportionate reactions to perceived attacks
*Perceives benign remarks as hidden humiliations
*Holding grudges

Question 20

Schizoid personality disorder
o Diagnostics: according to the DSM-5

Answer 20

At least 4 of the following criteria must be met
* Voluntary social withdrawal (e.g., family)
* Enjoys few activities
* Prefers solitary activities
* Lack of interest for close relationships
* Lacks people to trust or close friends
* Indifferent to praise or criticism
* Restricted emotional expression, flattened affect

Other features: comfortable with social isolation (unlike in avoidant personality disorder)

Question 21

schizoid PD vs avoidant

Answer 21

schizoid PD is comfortable with social isolation (unlike in avoidant personality disorder)

Question 22

Schizotypal personality disorder diagnostic

Answer 22

At least 5 of the following criteria must be met
* Odd and eccentric behavior or physical appearance
* Magical thinking
* Social awkwardness
* Excessive social anxiety
* Ideas of reference
* Unusual perceptual experiences (e.g., body illusions)
* Bizarre thinking/speech
* Paranoia and suspicion of others
* Constricted affect
* Few or no close friends
* Social anxiety and preference for social isolation because of paranoia that they cant connect with others

Question 23

Antisocial personality disorder diagnostic criteria

Answer 23

Adult
Criminal
Impulsive
Disregard for safety
Lying/cheating
Irresponsible
Aggression
Remorselessness

▪ The patient is at least 18 years of age
▪ 3 or more of the following symptoms of conduct disorder are present from at least 15 years of age
* Deceiving, manipulation
* A history of hostility and repeated aggression
* Repeatedly engaging in criminal activity
* Impulsivity/failure to plan ahead
* A reckless disregard for one’s own safety and/or the safety of others
* A failure to fulfill work-related or financial obligations
* A lack of empathy, remorse for their actions
▪ Antisocial behavior that is not only due to manifestations of bipolar disorder or schizophrenia

treatment is very difficult

Question 24

Borderline personality disorder diagnostic crit

Answer 24

▪ At least 5 of the following criteria must be met

• Unstable mood (e.g., irritability, anxiety)
• Intense anger that can be difficult to control
• Feelings of emptiness
• Self-damaging acts (e.g., unsafe sex, substance abuse, reckless behavior)
• Self-harm, suicidal behavior
• Unstable self-image
• Suspicion about what others think of them, even paranoid ideation and/or dissociative episodes
• Unstable personal relationships
• Fear of abandonment

Other features: splitting; a defense mechanism in which relationships are all good or all bad

Question 25

treatment of borderline PD

Answer 25

Treatment: dialectical behavior therapy

Question 26

Histrionic personality disorder o Diagnostics: according to the DSM-5

Answer 26

▪ At least 5 of the following criteria must be met * Attention-seeking: drawing attention to oneself by way of physical appearance * Uses dramatic speech * Exaggerated emotional expression * Not being the center of attention causes discomfort * Feelings are often shallow and unstable * Exhibiting inappropriate, sexually provocative, and/or seductive behavior during interactions with others * Easily influenced by others or circumstances * Overestimating the degree of intimacy in relationships

Question 27

Narcissistic personality disorder o Diagnostics: according to the DSM-5

Answer 27

▪ At least 5 of the following must be met * Excessive sense of self-importance * Fantasizes disproportionately about success, power, etc. * Believe in being special and a feeling of superiority * Great need for admiration * Expecting favorable treatment from others * Exploitation of others to achieve their own goals * Lack of empathy * Often envious of others * Often behaves arrogant and/or snobbish o Other features: difficulty dealing with criticism, fragile self-esteem

Question 28

Classification: 3 subtypes Narcissistic personality disorder

Answer 28

Grandiose, overt High-functioning Vulnerable/covert

Question 29

Avoidant personality disorder o Diagnostics: according to the DSM-5

Answer 29

▪ At least 4 of the following criteria must be met * Avoidance of interpersonal contact due to fear of criticism or rejection * Only interacts with people if certain of being liked by them * Restrained in intimate relationships due to fear of being ashamed * Preoccupation with and hypersensitivity to criticism * Feelings of inadequacy resulting in involuntary social withdrawal * Low self-esteem * Avoids taking risks and seldomly engages in new activities ▪ Strong desire for social relationships (unlike schizoid personalities), but limited by extreme shyness and social anxiety

Question 30

Dependent personality disorder o Diagnostics: according to DSM5

Answer 30

▪ At least 5 of the following must be met * Disproportionate need for support * Difficulty making everyday decisions (requiring others to assume responsibility) * Avoids disagreeing with others due to fear of losing their support * Difficulty initiating projects because of a lack of self-confidence * Makes extreme efforts to obtain support from others even if these efforts are unpleasant * Feelings of helplessness when alone * Urgently seeking new relationships when one fails * Both afraid of being abandoned and afraid to abandon their partner o Other features: often stuck in abusive relationships; associated with increased risk of suicide

Question 31

Obsessive-compulsive personality disorder o Diagnostics: according to DSM-5

Answer 31

▪ At least 4 of the following must be met * Excessive preoccupation with rules, lists, details, etc. * Obsession with work and productivity that often occurs at the expense of occupational success (e.g., missing deadlines), social relationships (e.g., excluding social activities to complete tasks), and pleasurable activities * Perfectionism that often interferes with task completion * Unwillingness to delegate work or to collaborate with other people * Great conscientiousness and fastidiousness, inflexible about matters of morality or ethics * Cling to worn-out/worthless items (even if they have no sentimental value) * Often show miserliness (e.g., obsessed with saving money for future disasters) * Rigid routines

Question 31

OCPD VS OCD

Answer 31

▪ In contrast to OCS, intrusive thoughts and repetitive behaviors are not present