Lecture 4: Personality Disorders Flashcards Preview

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Flashcards in Lecture 4: Personality Disorders Deck (16):

When do personality traits become disorders?

o When traits are so maladaptive that they significantly impair one’s work life and social life or cause major subjective distress


What are personality disorders?

o Inflexible and maladaptive responses to stress
o Global, affecting work and relationships
o Stable and enduring
o Non-psychotic, except under severe stress
o Ego-syntonic (the world is the problem, not me)
o Multiple complications


Age of onset of PD

Age of onset in late adolescence, early adulthood
(if later life personality changes -> look for medical causes!!)


modifiable over time?

studies suggest yes


Common co-morbid psychiatric conditions

i) Mood disorders
ii) Anxiety disorders
iii) Substance abuse/dependence


True/False. There is significant diagnostic overlap among PDs



prevalence of PD

(1) 1-5% of general population
(2) 10-30% of outpatients mental health facilities
(3) 15-30% of psychiatric inpatients


Gender differences

Antisocial PD male > female
Borderline PD female > male



i) Almost certainly a combination of biological and environmental factors.
(1) Example: Antisocial PD
(a) 1000+ children followed ages 3-21.
(b) 2 genetic polymorphisms: low MAO-A activity, hi MAO-A activity
(c) Maltreatment, no maltreatment
(d) Low MAO-A genotype + severe maltreatment -> antisocial behavior
(e) Hi MAO-A genotype + maltreatment -> no antisocial behavior


Borderline personality disorder

i) Among the most common PDs
ii) High users of health care
iii) Challenging patients
(1) Chronic suicidality
(2) Medication abuse
(3) Desperate care-seeking
(4) Intense anger
(5) Dividing a health care team into good guys and bad guys


Diagnostic criteria (at least 5) for Borderline personality disorder

(1) Frantic efforts to avoid abandonment
(2) Unstable, intense relationships
(3) Unstable self-image
(4) Self-damaging impulsivity
(5) Recurrent suicidal behavior, self-mutilation
(6) Affective instability
(7) Feelings of emptiness
(8) Intense and inappropriate or uncontrolled anger
(9) Transient paranoia or severe dissociative symptoms


Treatment options for personality disorders

i) treat co-morbid psychiatric disorders
ii) Biological Treatments
(1) Medication
iii) Psychosocial Treatments
(1) Psychotherapies
(a) Cognitive/behavioral
(b) Insight-oriented
(c) Supportive
(d) Individual/group/family
(2) Skills training, e.g., coping skills for managing self-harm urges or
emotional instability
iv) Alternative Treatments
(1) Self-help groups


Ground rules for treating people with personality disorders

i) Focus on behavior, not explanations of it
ii) Maintain a collaborative stance
iii) Attend to your own rescue fantasies
iv) Set limits on threats to safety
v) Do not shield patients from the consequences of their actions
vi) Manage your own feelings with support and consultation


Cluster A

odd or eccentric:
▪ Paranoid
▪ Schizoid
▪ Schizotypal


Cluster B:

dramatic, emotional, or erratic
▪ Antisocial
▪ Borderline
▪ Histrionic
▪ Narcissistic


Cluster C

anxious or fearful
▪ Avoidant
▪ Dependent
▪ Obsessive-compulsive