Flashcards in Lec 79 Personality Disorders Deck (30)
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1
Is there FDA approved treatment for personality disorders?
nope! just do psychotherapy
2
What is the core feature of all personality disorders?
difficulty in interpersonal functioning
3
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
4
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
5
Is personality disorder dimensional or categorical?
currently in DSM 5 = categorical = not on a continuum with normal personality
6
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
7
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]
8
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
9
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]
10
What is paranoid personality disorder?
- cluster A
- irrational suspicions and mistrust of others
- projection is major defense mech
11
What is schizoid personality disorder?
- cluster A
- voluntary social withdrawal, limited emotional expression,, content with social isolation
- schizoiD = Distant
12
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
13
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
14
What are characteristics of cluster C personality disorders? 3 types?
anxious or fearful; genetic association with anxiety disorders
avoidant, obsessive compulsive, dependent
15
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
16
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
17
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
18
What is histrionic personality disorder?
- cluster B
-pervasive attention-seeking, sexually provocative, overly concerned with appearance, excessive emotionality and excitablity
19
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
20
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
21
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]
22
What is dependent personality disorder?
- cluster C
- psychological dependence on others
- submissive and clinging
- excessive need to be taken care of
- low self-confidence
23
What 3 personality disorders most seen in clinic?
- schizotypal
- borderline
- avoidant
24
Which personality disorders more seen in men?
- antisocial personality disorder
25
Which personality disorders more seen in women?
- dependent
- histrionic
- borderline
26
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
27
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
28
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
29
What is neurobiology of avoidant PD?
inhibited temperament evident prenatally + infancy predicts
high amygdala activity similar to BPD
30
