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Flashcards in Lec 79 Personality Disorders Deck (30)
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Is there FDA approved treatment for personality disorders?

nope! just do psychotherapy


What is the core feature of all personality disorders?

difficulty in interpersonal functioning


What is the DSM-5 definition of personality disorder?

- enduring pattern of inner experience and behavior that deviates from expectations of one's culture. pattern manifests in 2 or more of the following: cognition, affectivity, interpersonal functioning, impulse control

- inflexible and pervasive pattern
- leads to clinically significant distress or impairment
- stable pattern of long duration, onset traced back at least to adolescence or early adulthood

person is not usually aware of the problem


What is development and course of personality disorder?

- person is not usually aware of the problem
- evident during adolescence or early adult life
- relatively stable over time
- hard to diagnose under age 18
- may be exacerbated by loss of significant support or previously stabilizing social situations


Is personality disorder dimensional or categorical?

currently in DSM 5 = categorical = not on a continuum with normal personality


What is difference axis 1 vs axis 2 disorders DSM4?

axis 1 = symptoms, episodic, pt suffers most, biologic, genetic, treat with meds
axis 2 = traits, stable, those around pt suffer most, psychological, development, treat with therapy


What are the 3 clusters of personality disorders?

cluster A = odd or eccentric [weird]
cluster B = dramatic, emotional, erratic [wild]
cluster C = anxious/fearful [worried]


What are the cluster A personality disorders? 3 types?

odd/eccentric, inability to develop meaningful social relationships, no psychosis, genetic association with schizophrenia
= Accusatory, Aloof, Awkward

3 types: paranoid, schizoid, schizotypal


WHat are the 3 personality clusters and their major characteristics [ABCs]?

cluster A = weird [accusatory, aloof, awkward]
cluster B = wild [bad to the bone]
cluster C = worried [cowardly, compulsive, clingy]


What is paranoid personality disorder?

- cluster A
- irrational suspicions and mistrust of others
- projection is major defense mech


What is schizoid personality disorder?

- cluster A
- voluntary social withdrawal, limited emotional expression,, content with social isolation
- schizoiD = Distant


What is schizotypal personality disorder?

- cluster A
- commonly co-occurs with paranoid PD = high rate of aggression often leading to criminal violence
- classic schizotypal: eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness, difficulty with working memory, lack of close friends, emotionally reserved
- schizoTypal = magical Thinking

don't look obviously mentally ill, could be misdiagnosed as depression, ADHD


What are characteristics of cluster B personality disorders? 4 types?

dramatic, emotional, erratic
- genetic association with mood disorders and substance abuse

- antisocial, borderlines, histrionic, narcissistic


What are characteristics of cluster C personality disorders? 3 types?

anxious or fearful; genetic association with anxiety disorders

avoidant, obsessive compulsive, dependent


Match the personality disorder cluster and which diseases it has genetic association with:

1. cluster A
2. cluster B
3. cluster C

A. mood disorders/substance abuse
B. anxiety disorders
C. schizophrenia

cluster A = schizophrenia
cluster B = mood disorders/substance abuse
cluster C = anxiety disorders


What is antisocial personality disorder?

- cluster B
- disregard for violation of rights of others
- criminality, impulsivity
- males > females; > 18yo and have conduct disorder before age 15
- if under age 18 its conduct disorder not personality disorder


What is borderline personality disorder?

- cluster B
- emotional instability [esp anger], hypersensitivity to interperonsal interactions esp. rejection, self-injury [to relieve pain], dissociatve symptoms, impulsivity esp aggression, intense unstable mood and interpersonal relationships, extreme "black and white" thinking, boredom, sense of emptiness
- female > male

- high suicide rate [distinct from self-injury]
- onset = adolescence but symptoms evident in child
- childhood trauma increases risk


What is histrionic personality disorder?

- cluster B
-pervasive attention-seeking, sexually provocative, overly concerned with appearance, excessive emotionality and excitablity


What is narcissistic personality disorder?

- cluster B
- grandiosity, sense of entitlement, lacks empathy and requires excessive admiration, often demands the "best" and reacts to criticism with rage


What is avoidant personality disorder?

- cluster C
- hypersensitive to rejection, socially inhibited, avoidance of social interactions, timid, feelings of inadequacy, desires relationships with others
- closely tied to social anxiety disorder
- pt desires affection/acceptance/relationships


What is obsessive-compulsive personality disorder?

- cluster C
- preoccupation with order, perfectionism, control
- rigid conformity to rules
- behavior consistent with one's own beliefs and attitudes [vs OCD has intuition]


What is dependent personality disorder?

- cluster C
- psychological dependence on others
- submissive and clinging
- excessive need to be taken care of
- low self-confidence


What 3 personality disorders most seen in clinic?

- schizotypal
- borderline
- avoidant


Which personality disorders more seen in men?

- antisocial personality disorder


Which personality disorders more seen in women?

- dependent
- histrionic
- borderline


What is neurobiology of schizotypal personality disorder? treat?

eye tracking abnormalities, temporal lobe volume loss, reduced striatal DA

treat = social skills training, low dose antipsychotics


What are neuro models of borderline personality disorder?

- amygdala-OFC disconnection --> emotional dysregulation = made worse by benzos/alc

- fialure in habituation to negative emotional stimuli --> reviewing painful memories worsens symptoms + increases self-injury

- social cognition dysfunction --> decreased activity in insula during social interaction, difficult identifying feels in self and others = lack of gut feeling that there is a problem with a relationship


What is course of borderline personality disorder?

- impairment and suicide risk decrease with age + relationships stabilize
- if therapy --> benefit w/in 1 yr
- after 10 yrs up to 50% no longer have pattern of behavior that meets full criteria for borderline personality disorder
- 10% commit suicide


What is neurobiology of avoidant PD?

inhibited temperament evident prenatally + infancy predicts
high amygdala activity similar to BPD


What is treatment for avoidant PD?

psychoanalytic psychotherapy, social skills training, antidepressant