Personality D/O

Question 1

Personality disorder definition

Answer 1

an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time and leads to distress or impairment

Question 2

General Personality Disorder Criteria (DSM V)

Answer 2

An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture. This is manifested in two or more of the following areas:
Cognition
Affectivity
Interpersonal functioning
Impulse control
The enduring pattern is inflexible and pervasive across a broad range of personal and social situations
The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood
The enduring pattern is not better explained as a manifestation or consequence of another mental disorder.
The enduring pattern is not attributable to the physiological effects of a substance or another medical condition.

Question 3

General Personality D/O

Answer 3

Maladaptive thoughts (misperceptions and misinterpretations)
Distorted worldview
Intrapersonal- one’s thoughts of one’s self
Interpersonal- one’s thoughts regarding one’s environment
Atypical behavior/lifestyle

Question 4

Development and Course of General Personality D/O

Answer 4

Features usually become recognizable during adolescence or early adulthood
Some tend to become less evident or remit w/ age (ex. Antisocial and borderline)
Some become more evident w/ age (ex. Obsessive compulsive and schizotypal)
If diagnosed < 18 years of age, features must have been present for at least 1 year
Exception of antisocial PD which cannot be diagnosed in patients <18 years of age
If a change in personality develops in middle age or later in life, consider other medical conditions or substance use d/o

Question 5

Epidemiology of Personality D/O

Answer 5

More common in males:
Antisocial, paranoid, schizoid,
More common in female:
Borderline, histrionic and dependent

Question 6

3 types of clusters associated with personality d/o

Answer 6

Cluster A
Cluster B
Cluster C

Question 7

Cluster A

Answer 7

Odd or eccentric behavior

Cognitive distortions

Question 8

Cluster B

Answer 8

Overly emotional

Dramatic and unpredictable

Question 9

Cluster C

Answer 9

Anxious or fearful behavior

Avoids confrontation, withdrawn

Question 10

3 types of personality d/o within cluster a?

Answer 10

Paranoid
Schizoid
Schizotypal

Question 11

Cluster A- Paranoid

Answer 11

Distrust and suspicious of others, motives of others are viewed as malicious
Does not occur exclusively during the course of schizophrenia, bipolar, depressive d/o w/ psychotic features or another psychotic d/o and not d/t another medical condition

Question 12

What are some issues assocaited with Cluster A Paranoid people

Answer 12

Difficult to get along with
Have problems w/ close relationships
May act in a guarded, secretive manner d/t paranoid behavior
Labile range of affect
B/c they tend to be combative and suspicious, they may get hostile responses from others, which only confirms their behavior
Strong need to be self-sufficient and sense of autonomy

Question 13

Cluster A- Paranoid Epidemiology

Answer 13

Prevalence 2.3%
More common in males
Increased prevalence if FH of schizophrenia and delusional d/o
May present in childhood and adolescence

Question 14

Cluster A-Schizoid

Answer 14

Pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings beginning in early adulthood

Question 15

What are some issues assocaited with Cluster A Schizoid people

Answer 15

Socially isolated, “loners”
Lack intimacy
Prefer mechanical or abstract tasks (computer games)
Indifferent to approval/criticism of others
Have difficulty expressing anger, show little emotion
Respond inappropriately to important life events

Question 16

Cluster A- Schizoid epidemiology

Answer 16

Prevalence of 4.9%
Increased prevalence if FH of schizophrenia or schizotypal PD
Slightly more common in males
May first appear in childhood as solitariness, poor peer relationships, underachievement in school, subject to teasing

Question 17

Cluster A- Schizotypal

Answer 17

Pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for close relationships as well as cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in variety of contexts

Question 18

Cluster A- Schizotypal has what characteristics?

Answer 18

Interpret things incorrectly w/ unusual meaning
Superstitious or preoccupied w/ paranormal phenomona
Feel they have special powers to sense future events or read other’s thoughts
Speech may have unusual phrasing w/ speech and vague
May be suspicious and have paranoid ideation
Unusual mannerisms, unkempt dress and inattentive to normal social reactions (avoid eye contact, wear ill fitting clothes, unable to join in give & take banter of coworkers)
Uncomfortable relating to others
Lack of intimacy and few friends

Question 19

Cluster A- Schizotypal epidemiology

Answer 19

Prevalence- 4.6% US
More prevalent if FH of schizophrenia in 1st degree relative
Slightly more common in males
May first appear in childhood as being solitary (avoiding social interactions w/ others), poor peer relationships, social anxiety, underachievement in school, hypersensitivity, peculiar thoughts and language, bizarre fantasies, subject to teasing

Question 20

4 personality d/o associated with cluster B

Answer 20

Antisocial
Borderline
Histrionic
Narcissistic

Question 21

Cluster B- Antisocial

Answer 21

Pervasive pattern of disregard for and violation of the rights of others, since the age of 15 years, by demonstration of 3 (or more):
Failure to conform to social norms w/ respect to lawful behaviors (repeating acts that are grounds for arrest)
Deceitful
Impulsive, failure to plan ahead
Irritable and aggressive
Reckless disregard for the safety of oneself and others
Consistently irresponsible
Lack of remorse (indifferent to or rationalize hurting others)
At least 18 years of age
Evidence of a conduct disorder before the age of 15
Does not occur exclusively during the course of schizophrenia or bipolar disorder

Question 22

Conduct disorder behaviors associated with cluster B- antisocial

Answer 22

Aggression to people and animals
Destruction of property
Deceitfulness or theft
Serious violations of rules

Question 23

Epidemiology of cluster b- antisocial

Answer 23

Prevalence: 0.2-3.3%
Highest prevalence (>70%) is among most severe samples of males w/ ETOH disorder, and from substance abuse clinics or prisons
More common in males
Risk factors include genetic

Question 24

Cluster B- Borderline

Answer 24

Pervasive pattern of instability or interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in 5 (or more) contexts:
Frantic efforts to avoid real or imagined abandonment
Pattern of unstable and intense interpersonal relationships
Identity disturbance (self-image/sense of self)
Impulsivity in at least 2 areas that are potentially self damaging (spending, sex, substance abuse, reckless driving, binge eating)
Recurrent suicidal behavior, gestures or threats or self-mutilating behavior
Affective instability (marked mood changes)
Chronic feelings of emptiness
Inappropriate intense anger or difficulty controlling anger
Transient, stress-related paranoid ideation or severe dissociative symptoms

Question 25

Cluster B borderline epidemiology

Answer 25

Prevalence rate of 1-2% More common in females (75%) High rate of childhood sexual, physical and/or emotional abuse in these patients 5 x more common among first degree relatives w/ the disorder Bipolar and MDD occur more commonly in families w/ Borderline personality disorder

Question 26

Cluster B- Histrionic

Answer 26

Pervasive pattern of excessive emotionality and attention seeking starting in early adulthood and present in 5 (or more) contexts: Uncomfortable in situations where he/she is not the center of attention Interaction w/ others is characterized by inappropriate sexually seductive or provocative behavior Rapidly shifting expression of emotions Consistently uses physical appearance to draw attention to self Style of speech is excessively impressionistic and lacking in detail Shows self-dramatization, theatricality, and exaggerated expression of emotion Is easily influenced by others or circumstances Considers relationships more intimate than they actually are

Question 27

Characteristics of cluster B histrionic

Answer 27

Want to be “life of the party”, if not, they do something dramatic (make up a story/create a scene) to draw attention Constantly want to impress others Tend to spend excessive amounts of time, energy and money on clothes and grooming “fish for compliments” regarding appearance to draw attention Strong opinions are expressed w/ dramatic flair (supporting facts are vague) Often display excessive public displays of emotion that they can turn off/on quickly (accused of faking) Easily influenced by others

Question 28

Epidemiology of Cluster B Histrionic?

Answer 28

Prevalence rate of 1-3% in general population More common in females Etiology: ? Parent-child relationship leads to low self esteem Risk factors: ?

Question 29

Cluster B- Narcissistic

Answer 29

Grandiose, need for admiration and lack of empathy Boastful Insist on only seeing the best person (ex. Doctor, hairdresser, etc) Sense of entitlement (expect to be catered to and furious if they are not, rules don’t apply to them) Believe that others are completely concerned about their welfare, but they do not recognize that others have feelings/needs as well and if recognized, they are viewed as weaknesses or vulnerability Become involved in friendships/romances only if the other person will continuously enhance their self-esteem

Question 30

Cluster B- Narcissistic characteristics

Answer 30

Self esteem very fragile Very sensitive to criticism or defeat d/t vulnerability in self-esteem Criticism may haunt them or leave them feeling humiliated and degraded which they will not outwardly express May react w/ rage, disdain or a counterattack High ambition and confidence often lead to high achievement

Question 31

Cluster B- Narcissistic epidemiology

Answer 31

Prevalence rate of females (50-75% males) | Etiology- unknown,

Question 32

Cluster C- Avoidant

Answer 32

Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in 4 (or more) contexts: Avoids occupational activities that involve significant interpersonal contact d/t fear of criticism, disapproval or rejection Unwilling to get involved w/ people unless certain of being liked Shows restraint w/in intimate relationships b/c of the fear of being shamed/ridiculed Preoccupied w/ being criticized or rejected in social situations Is inhibited in new interpersonal situations b/c of feelings of inadequacy Views self as socially inept, unappealing or inferior to others Unusually reluctant to take personal risks or to engage in any new activities b/c they may be embarassing

Question 33

Cluster C- Avoidant characteristics

Answer 33

Often decline job promotions (fear) Avoid making new friends unless certain thay would be liked/accepted Interpersonal intimacy is difficult Have difficulty talking about themselves Low self esteem, introverted/shy (fear) They want to be active socially, but fear gets in the way Exaggerate potential dangers of ordinary situations Hypersensitive to rejection

Question 34

Cluster C- Avoidant epidemiology

Answer 34

Prevalence rate 0.5-2.4% of gen population Males = females Etiology- unknown Starts in infancy or childhood w/ shyness, isolation and fear of strangers and new situations.

Question 35

Cluster C- Dependent

Answer 35

Pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning in early adulthood and present in 5 (or more contexts): Difficulty making everyday decisions w/o excessive advice and reassurance from others Needs others to assume responsibility for most major areas of life Difficulty expressing disagreement w/ others b/c of fear of loss of support or approval Difficulty initiating projects or doing things on their own (lack self-confidence) Goes to excessive lengths to obtain nurturance and support from others Feels uncomfortable or helpless when alone Urgently seeks another relationship when a close relationship ends Unrealistically pre-occupied w/ fears of being left to take care of themselves

Question 36

Cluster C- Dependent characteristics

Answer 36

``` Believe they cannot fx on their own Passive Lack self-confidence/lots of self-doubt Submissive to others (even if unreasonable) Feel helpless when alone Often pessimistic Often co-occur w/ Cluster B PD Chronic illness or separation anxiety ```

Question 37

Cluster C- Dependent epidemiology

Answer 37

Prevalence: 0.5% of general population Females > Males Etiology unknown

Question 38

Cluster C- Obsessive Compulsive

Answer 38

Pervasive pattern of preoccupation w/ orderliness, perfectionism and mental and interpersonal control, at the expense of flexibility, openness and efficicency, beginning by early adulthood and present in 4 (or more) contexts: Preoccupied w/ details, rules, lists, order etc to the point where the major point is lost Shows perfectionism that interferes w/ task completion Excessively devoted to work and productivity to the exclusion of leisure activities and friendships Overconscientious, scrupulous and inflexible about morals, ethics and values Unable to discard worn out or worthless objects even if it has no sentimental value Reluctant to delegate tasks or work w/ others Money is viewed as something to be hoarded for future catastrophes Rigid and stubborn

Question 39

Cluster C- Obsessive Compulsive characteristics

Answer 39

Increased need for sense of control Prone to repetition, increased attention to detail and repeatedly checking for mistakes Oblivious to others who get annoyed w/ their behavior Sets high standards/perfectionist that causes distress and dysfunction Reject help, do not break rules “pack rats” Plan ahead in meticulous detail and unwilling to consider changes

Question 40

Cluster C- Obsessive Compulsive epidemiology

Answer 40

Prevalence rate: 2-8% (most prevalent PD in general population) Males > females Etiology- unknown

Question 41

Why are personality d/o difficult to treat?

Answer 41

Often do not cause personal distress They are experienced as a fundamental part of the individual Individual has limited insight into the nature of the problem

Question 42

Cluster A treatment?

Answer 42

Psychotherapy (individual or group settings) | Group/Family therapy

Question 43

Cluster B treatment

Answer 43

``` Psychotherapy (Individual)/CBT Group/Family therapy Community programs- particularly antisocial Decrease in 20-40% of criminal behavior Psychopharmacology: ```

Question 44

Cluster C treatment

Answer 44

``` Avoidant: Psychopharm- ?SSRIs, MAOI’s Psychotherapy- individual and exposure therapy Dependent: Psychopharm- SSRI and TCA’s helpful for symptoms of anxiety, fatigue and malaise. Psychotherapy OCD: Psychopharm- not shown to be effective Psychotherapy ```