Personality Disorders Flashcards
(151 cards)
1
Q
DSM criteria for a general personality disorder
A
A. An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas:
1. Cognition (i.e., ways of perceiving and interpreting self, other people, and events).
2. Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response).
3. Interpersonal functioning.
4. Impulse control.
B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
C. The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.
E. The enduring pattern is not better explained as a manifestation or consequence of another mental disorder.
F. The enduring pattern is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., head trauma).
Quicker overview:
A personality disorder is:
- an enduring pattern of inner
experience and behavior that deviates markedly from the norms and expectations of the individual’s culture and is manifested through cognition, affectivity, interpersonal functioning or impulse control.
- is pervasive and inflexible
- has an onset in adolescence or early adulthood
- is stable over time
- leads to distress or impairment.
2
Q
What are the three Cluster A personality disorders and the main/core pattern in each?
A
- Paranoid personality disorder is a pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent.
- Schizoid personality disorder is a pattern of detachment from social relationships and a restricted range of emotional expression.
- Schizotypal personality disorder is a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behaviour.
odd or eccentric
3
Q
What are the four Cluster B personality disorders and the main/core pattern in each?
A
- Antisocial personality disorder is a pattern of disregard for, and violation of, the rights of others, criminality, impulsivity, and a failure to learn from experience.
- Borderline personality disorder is a pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity.
- Histrionic personality disorder is a pattern of excessive emotionality and attention seeking.
- Narcissistic personality disorder is a pattern of grandiosity, need for admiration, and lack of empathy.
Dramatic, emotional, erratic
4
Q
What are the three Cluster C personality disorders and the main/core pattern in each?
A
- Avoidant personality disorder is a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.
- Dependent personality disorder is a pattern of submissive and clinging behavior related to an excessive need to be taken care of.
- Obsessive-compulsive personality disorder is a pattern of preoccupation with orderliness, perfectionism, and control.
anxious or fearful
5
Q
Prevalence of Cluster A, B, C, and any personality disorder?
A
A review of epidemiological studies from several countries found a median prevalence of 3.6% for disorders in Cluster A, 4.5% for Cluster B, 2.8% for Cluster C, and 10.5% for any personality disorder.
6
Q
Can you diagnose a personality disorder in individuals less than 18?
A
Yes if the traits have been present for 1 year, except for ASPD where you must be 18 or older.
Personality disorder categories may be applied with children or adolescents in those relatively unusual instances in which the individual’s particular maladaptive personality traits appear to be pervasive, persistent, and unlikely to be limited to a particular developmental stage or attributable to another mental disorder.
It should be recognized that the traits of a personality disorder that appear in childhood will often not persist unchanged into adult life. For a personality disorder to be diagnosed in an individual younger than 18 years, the features must have been present for at least 1 year. The one exception to this is antisocial personality disorder, which cannot be diagnosed in individuals younger than 18 years.
7
Q
Men vs women likelihood of being diagnosed with Cluster B disorders?
A
Certain personality disorders (e.g., antisocial personality disorder) are diagnosed more frequently in men. Others (e.g., borderline, histrionic, and dependent personality disorders) are diagnosed more frequently in women; however, in the case of borderline personality disorder, this may be due to higher help-seeking among women.
8
Q
DSM Criteria for Paranoid PD?
A
A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
- Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
- Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
- Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
- Reads hidden demeaning or threatening meanings into benign remarks or events.
- Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
- Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
- Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.
Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition.
Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” i.e., “paranoid personality disorder (premorbid).”
9
Q
What disorder does this:
Individuals with this disorder assume that other people will exploit, harm, or deceive them, even if no evidence exists to support this expectation. They suspect on the basis of little or no evidence that others are plotting against them and may attack them suddenly, at any time and without reason. They often feel that they have been deeply and irreversibly injured by another person or persons even when there is no objective evidence for this.
A
Paranoid Personality Disorder (criterion A1)
10
Q
They are preoccupied with unjustified doubts about the loyalty or trustworthiness of their friends and associates, whose actions are minutely scrutinized for evidence of hostile intentions.
Any perceived deviation from trustworthiness or loyalty serves to support their underlying assumptions. They are so amazed when a friend or associate shows loyalty that they cannot trust or believe it. If they get into trouble, they expect that friends and associates will either attack or ignore them.
Dx?
A
Paranoid Personality disorder
Criterion A2:
Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
11
Q
They may refuse to answer personal questions, saying that the information is “nobody’s business.”
dx?
A
Paranoid Personality Disorder
Criterion A3: Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her
12
Q
An individual with this disorder may misinterpret an honest mistake by a store clerk as a deliberate attempt to shortchange, or view a casual humorous remark by a coworker as a serious character attack. Compliments are often misinterpreted (e.g., a compliment on a new acquisition is misinterpreted as a criticism for selfishness; a compliment on an accomplishment is misinterpreted as an attempt to coerce more and better performance). They may view an offer of help as a criticism that they are not doing well enough on their own.
Dx?
A
Paranoid personality disorder
A4: Reads hidden demeaning or threatening meanings into benign remarks or events
13
Q
Minor slights arouse major hostility, and the hostile feelings persist for a long time. Because they are constantly vigilant to the harmful intentions of others, they very often feel that their character or reputation has been attacked or that they have been slighted in some other way.
Dx?
A
Paranoid PD.
Criterion A5: Persistently bears grudges
14
Q
Individuals with ______ personality disorder are generally difficult to get along with and often have problems with close relationships. Their excessive suspiciousness and hostility may be expressed in overt argumentativeness, in recurrent complaining, or by hostile aloofness. They display a labile range of affect, with hostile, stubborn, and sarcastic expressions predominating. Their combative and suspicious nature may elicit a hostile response in others, which then serves to confirm their original expectations.
A
Paranoid
15
Q
They need to have a high degree of control over those around them. They are often rigid, critical of others, and unable to collaborate, although they have great difficulty accepting criticism themselves. They may blame others for their own shortcomings.
Dx?
A
Paranoid PD
Because they lack trust in others
16
Q
Because of their quickness to counterattack in response to the threats they perceive around them, they may be litigious and frequently become involved in legal disputes.
Dx?
A
Paranoid PD
17
Q
They may exhibit thinly hidden, unrealistic grandiose fantasies, are often attuned to issues of power and rank, and tend to develop negative stereotypes of others, particularly those from population groups distinct from their own. Attracted by simplistic formulations of the world, they are often wary of ambiguous situations. They may be perceived as “fanatics” and form tightly knit “cults” or groups with others who share their belief systems.
dx?
A
Paranoid PD
18
Q
Prevalence of paranoid PD?
A
Probably about 2-4%, but high in forensic settings, up to 20%.
National Comorbidity Survey Replication was 2.3%. The prevalence of paranoid personality disorder in the National Epidemiologic Survey on Alcohol and Related Conditions was 4.4%. A review of six epidemiological studies (four in the United States) found a median prevalence of 3.2%. In forensic settings, the estimated prevalence may be as high as 23%.
19
Q
Environmental risk factors for paranoid PD?
A
Basically social stress and childhood trauma.
DSM:
1) Exposure to social stressors such as socioeconomic inequality, marginalization, and racism is associated with decreased trust, which in some cases is adaptive.
2) Both longitudinal and cross-sectional studies confirm that childhood trauma is a risk factor for paranoid personality disorder.
20
Q
Genetic risk factors for paranoid PD?
A
If you’re related to someone with SCZ or delusional disorder, persecutory type, may have higher risk.
There is some evidence for an increased prevalence of paranoid personality disorder in relatives of probands with schizophrenia and for a more specific familial relationship with delusional disorder, persecutory type.
21
Q
Paranoid PD rates in men vs women?
How about schizoid PD rates in men vs women?
Schizotypal?
A
Unclear for paranoid and schizoid.
While paranoid personality disorder was found to be more common in men than in women in a meta-analysis relying on clinical and community samples, the National Epidemiologic Survey on
Alcohol and Related Conditions found it to be more common in women.
While some research suggests that schizoid personality disorder may be more common in men, other research suggests that there is no gender difference in prevalence.
Schizotypal personality disorder appears to be slightly more common in men than in women.
22
Q
How to tell paranoid from schizotypal?
A
Paranoid personality disorder and schizotypal personality disorder share the traits of suspiciousness, interpersonal aloofness, and paranoid ideation, but schizotypal personality disorder also includes symptoms such as magical thinking, unusual perceptual experiences, and odd thinking and speech. Individuals with behaviors that meet criteria for schizoid personality disorder are often perceived as strange, eccentric, cold, and aloof, but they do not usually have prominent paranoid ideation
23
Q
Comorbidities with paranoid PD?
A
Alcohol and other substance use disorders frequently occur.
The most common co-occurring personality disorders appear to be schizotypal, schizoid, narcissistic, avoidant, and borderline.
Particularly in response to stress, individuals with this disorder may experience very brief psychotic episodes (lasting minutes to hours).
In some instances, paranoid personality disorder may appear as the premorbid antecedent of delusional disorder or schizophrenia.
Individuals with paranoid personality disorder may develop major depressive disorder and may be at increased risk for agoraphobia and obsessive-compulsive disorder.
24
Q
DSM criteria for Schizoid Personality Disorder?
A
A. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
- Neither desires nor enjoys close relationships, including being part of a family.
- Almost always chooses solitary activities.
- Has little, if any, interest in having sexual experiences with another person.
- Takes pleasure in few, if any, activities.
- Lacks close friends or confidants other than first-degree relatives.
- Appears indifferent to the praise or criticism of others.
- Shows emotional coldness, detachment, or flattened affectivity.
Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder and is not attributable to the physiological effects of another medical condition.
Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” i.e., “schizoid personality disorder (premorbid).”
25
They prefer mechanical or abstract tasks, such as computer or mathematical games.
There is usually a reduced experience of pleasure from sensory, bodily, or interpersonal experiences, such as walking on a beach at sunset or having sex.
Dx?
Schizoid Personality Disorder
(think robot)
26
They may be oblivious to the normal subtleties of social interaction and often do not respond appropriately to social cues so that they seem socially inept or superficial and self- absorbed.
They usually display a “bland” exterior without visible emotional reactivity and rarely reciprocate gestures or facial expressions, such as smiles or nods.
Dx?
Schizoid Personality Disorder
(think robot)
27
They claim that they rarely experience strong emotions such as anger and joy. They often display a constricted affect and appear cold and aloof. However, in those very unusual circumstances in which these individuals become at least temporarily comfortable in revealing themselves, they may acknowledge having painful feelings, particularly related to social interactions.
Dx?
Schizoid Personality Disorder
(think robot)
28
Individuals with ______ personality disorder may have particular difficulty expressing anger, even in response to direct provocation, which contributes to the impression that they lack emotion. Their lives sometimes seem directionless, and they may appear to “drift” in their goals.
Such individuals often react passively to adverse circumstances and have difficulty responding appropriately to important life events.
Because of their lack of social skills and lack of desire for sexual experiences, individuals with this disorder have few friendships, date infrequently, and often do not marry.
Occupational functioning may be impaired, particularly if interpersonal involvement is required, but individuals with this disorder may do well when they work under conditions of social isolation.
Schizoid Personality Disorder
29
Prevalence of Schizoid PD?
Schizoid personality disorder is uncommon in clinical settings. The estimated prevalence of schizoid personality disorder based on a probability subsample from Part II of the National Comorbidity Survey Replication was 4.9%. The prevalence of schizoid personality disorder in the National Epidemiologic Survey on Alcohol and Related Conditions was 3.1%. A review of six epidemiological studies (four in the United States) found a median prevalence of 1.3%.
30
Genetic risk factors for schizoid personality disorder?
Schizoid personality disorder may have increased prevalence in the relatives of individuals with schizophrenia or schizotypal personality disorder.
31
Comorbidity with schizoid personality disorder?
Particularly in response to stress, individuals with this disorder may experience very brief psychotic episodes (lasting minutes to hours).
In some instances, schizoid personality disorder may appear as the premorbid antecedent of delusional disorder or schizophrenia.
Individuals with this disorder may sometimes develop major depressive disorder.
Schizoid personality disorder most often co-occurs with schizotypal, paranoid, and avoidant personality disorders.
32
DSM 5 criteria for Schizotypal PD?
A. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by
cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. Ideas of reference (excluding delusions of reference).
2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupations).
3. Unusual perceptual experiences, including bodily illusions.
4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).
5. Suspiciousness or paranoid ideation.
6. Inappropriate or constricted affect.
7. Behavior or appearance that is odd, eccentric, or peculiar.
8. Lack of close friends or confidants other than first-degree relatives.
9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.
Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder.
Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” e.g., “schizotypal personality disorder (premorbid).”
33
What are ideas of reference, what disorder are they seen in, and how to distinguish from delusions of reference?
ideas of reference (i.e., incorrect interpretations of casual incidents and external events as having a particular and unusual meaning specifically for the person). These should be distinguished from delusions of reference, in which the beliefs are held with delusional conviction.
Schizotypal PD.
34
Examples of odd beliefs or magical thinking seen in schizotypal PD?
These individuals may be superstitious or preoccupied with paranormal phenomena that are outside the norms of their subculture (Criterion A2). They may feel that they have special powers to sense events before they happen or to read others’ thoughts. They may believe that they have magical control over others, which can be implemented directly (e.g., believing that their spouse’s taking the dog out for a walk is the direct result of thinking an hour earlier it should be done) or indirectly through compliance with magical rituals (e.g., walking past a specific object three times to avoid a certain harmful outcome)
35
Perceptual alterations may be present (e.g., sensing
that another person is present or hearing a voice murmuring their name) in what PD?
Schizotypal PD
3. Unusual perceptual experiences, including bodily illusions.
36
Their speech may include unusual or idiosyncratic phrasing and construction. It is often loose, digressive, or vague, but without actual derailment or incoherence (Criterion A4). Responses can be either overly concrete or overly abstract, and words or concepts are sometimes applied in unusual ways (e.g., the individual may state that he or she was not “talkable” at work).
Dx?
Schizotypal PD
4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).
37
Individuals with this disorder are often suspicious and may have paranoid ideation (e.g., believing their colleagues at work are intent on undermining their reputation with the boss).
Schizotypal PD.
5. Suspiciousness or paranoid ideation.
38
They are usually not able to negotiate the full range of affects and interpersonal cuing required for successful relationships and thus often appear to interact with others in an inappropriate, stiff, or constricted fashion
Dx?
Schizotypal PD
6. Inappropriate or constricted affect.
39
These individuals are often considered to be odd or eccentric because of unusual mannerisms, an often unkempt manner of dress that does not quite “fit together,” and inattention to the usual social conventions (e.g., the individual may avoid eye contact, wear clothes that are ink stained and ill-fitting, and be unable to join in the give-and-take banter of co-workers)
Dx?
7. Behavior or appearance that is odd, eccentric, or peculiar.
40
Individuals with _______ personality disorder experience interpersonal relatedness as problematic and are uncomfortable relating to other people. Although they may express unhappiness about their lack of relationships, their behavior suggests a decreased desire for intimate contacts. As a result, they usually have no or few close friends or confidants other than a first-degree relative
Schizoid PD
8. Lack of close friends or confidants other than first-degree relatives.
41
They will interact with other individuals when they have to but prefer to keep to themselves because they feel that they are different and just do not “fit in.” Their social anxiety does not easily abate, even when they spend more time in the setting or become more familiar with the other people, because their anxiety tends to be associated with suspiciousness regarding others’ motivations. For example, when attending a dinner party, the individual with _____________
personality disorder will not become more relaxed as time goes on, but rather may become increasingly tense and suspicious.
Schizoid PD
9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.
42
Prevalence of schizoid PD?
The estimated prevalence of schizotypal personality disorder based on a probability subsample from Part II of the National Comorbidity Survey Replication was 3.3%.The prevalence of schizotypal personality disorder in the National Epidemiologic Survey on Alcohol and Related Conditions data was 3.9%. A review of five epidemiological studies (three in the United States) found a median prevalence of 0.6%.
43
Development and course of schizotypal PD?
Schizotypal personality disorder has a relatively stable course, with only a small proportion of individuals going on to develop schizophrenia or another psychotic disorder.
Schizotypal personality disorder may be first apparent in childhood and adolescence with solitariness, poor peer relationships, social anxiety, underachievement in school, hypersensitivity, peculiar thoughts and language, and bizarre fantasies. These children may appear “odd” or “eccentric” and attract teasing.
44
Genetic risk factors for schizotypal PD?
tends to run in families. higher risk for schizotypal PD if you've got a first-degree relative with SCZ. Slight increase in SCZ/other psychotic illnesses if you're related to someone with schizotypal PD.
Schizotypal personality disorder appears to aggregate familially and is more prevalent among the first-degree biological relatives of individuals with schizophrenia than among the general population.
There may also be a modest increase in schizophrenia and other psychotic disorders in the relatives of probands with schizotypal personality disorder.
Twin studies indicate highly stable genetic factors and rather transient environmental factors for an increased risk for the schizotypal syndrome, and genetic risk variants for schizophrenia may be linked to schizotypal personality disorder.
Neuroimaging studies detect group-level differences in the size and function of specific brain regions in individuals with schizotypal personality disorder in comparison with healthy persons, individuals with schizophrenia, and individuals with other personality disorders.
45
Comorbidities with schizotypal?
Particularly in response to stress, individuals with this disorder may experience transient psychotic episodes (lasting minutes to hours), although they usually are insufficient in duration to warrant an additional diagnosis such as brief psychotic disorder or schizophreniform disorder.
In some cases, clinically significant psychotic symptoms may develop that meet criteria for brief psychotic disorder, schizophreniform disorder, delusional disorder, or schizophrenia.
There is considerable co-occurrence with schizoid, paranoid, avoidant, and borderline personality disorders.
46
DSM criteria for antisocial PD?
A. A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following:
1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
3. Impulsivity or failure to plan ahead.
4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
5. Reckless disregard for safety of self or others.
6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
The individual is at least age 18 years.
There is evidence of conduct disorder with onset before age 15 years.
D. The occurrence of antisocial behavior is not exclusively during the course of
schizophrenia or bipolar disorder.
47
Environmental risk factors for ASPD?
Child abuse or neglect, unstable or erratic parenting, or inconsistent parental discipline may increase the likelihood that conduct disorder will evolve into antisocial personality disorder.
48
Genetic risk factors for antisocial PD?
Antisocial personality disorder is more common among the first-degree biological relatives of those with the disorder than in the general population.
Biological relatives of individuals with this disorder are also at increased risk for somatization disorder (a diagnosis that was replaced in DSM-5 with somatic symptom disorder) and substance use disorders.
Within a family that has a member with antisocial personality disorder, males more often have antisocial personality disorder and substance use disorders, whereas females more often have somatization disorder.
NOTE:
The likelihood of developing antisocial personality disorder in adult life is increased if the individual experienced childhood onset of conduct disorder (before age 10 years) and accompanying attention-deficit/hyperactivity disorder.
49
Men vs women prevalence of antisocial PD?
Antisocial personality disorder is three times as common in men than in women.
Clinical presentation may vary, with men more often presenting with irritability/aggression and reckless disregard for the safety of others compared with women.
There has been some concern that antisocial personality disorder may be underdiagnosed in females, particularly because of the emphasis on aggressive items in the definition of conduct disorder.
50
Comorbid conditions seen with antisocial PD?
Comorbid substance use disorders are more common in men, while comorbid mood and anxiety disorders are more common in women.
Individuals with antisocial personality disorder may also experience dysphoria, including complaints of tension, inability to tolerate boredom, and depressed mood.
They may have associated anxiety disorders, mood disorders, substance use disorders, somatic symptom disorder, and gambling disorder.
Individuals with antisocial personality disorder also often have personality features that meet criteria for other personality disorders, particularly borderline, histrionic, and narcissistic personality disorders.
51
Individuals with _______ personality disorder frequently lack empathy and tend to be callous, cynical, and contemptuous of the feelings, rights, and sufferings of others. They may have an inflated and arrogant self-appraisal (e.g., feel that ordinary work is beneath them or lack a realistic concern about their current problems or their future) and may be excessively opinionated, self-assured, or cocky. Some _____ individuals may display a glib, superficial charm and can be quite voluble and verbally facile (e.g., using technical terms or jargon that might impress someone who is unfamiliar with the topic).
Dx?
Antisocial PD
52
DSM criteria for Borderline PD?
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more
than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays
of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.
53
Mnemonic for borderline PD?
The mnemonic IMPULSIVE can be used to remember the criteria for borderline personality disorder.
I - Impulsive: “Are you by nature an impulsive person? (e.g. - shop lifting, binging, gaming)”
M - Moodiness: “Do you find it difficult to control your emotions?”
P - Paranoia or dissociation under stress: “Do you ever feel you dissociate or feel things aren't real during stress (e.g. - zoning out, feeling like in a dream, or feeling the world around you isn't real)?”
U - Unstable self-image: “Do you feel that you have a poor sense of who you are and your identity?” “How would you describe yourself as a person?” “What are you interests?” “Ever have uncertainty about sexual orientation?” “What are your values as a person?”
L - Labile intense relationships: “Are your romantic relationships intense, where people can be amazing one moment but awful the next?”
S - Suicidal gestures: “Do you self-harm?”
I - Inappropriate anger: “Are you quick to anger?”
V - Vulnerability to abandonment: “Is it hard for you when people in your life leave you? Do you have a constant fear of being abandoned by others?”
E - Emptiness: “Do you frequently feel empty inside?” (Emptiness is a unique feeling in BPD - either you have it or you don't)
54
Individuals with ______ personality disorder may have a pattern of undermining themselves at the moment a goal is about to be realized (e.g., dropping out of school just before graduation; regressing severely after a discussion of how well therapy is going; destroying a good relationship just when it is clear that the relationship could last).
borderline
55
Some individuals develop psychotic-like symptoms (e.g., hallucinations, body-image distortions, ideas of reference, hypnagogic phenomena) during times of stress.
dx?
Borderline PD
56
Individuals with this disorder may feel more secure with transitional objects (i.e., a pet or inanimate possession) than in interpersonal relationships.
dx?
Borderline PD
57
Prevalence of Borderline in gen pop?
primary care settings?
outpatient MH clinics?
psych inpatients?
Gen pop: between 1.4 - 5.9, probably about 2-3%.
The prevalence of borderline personality disorder is about 6% in primary care settings, about 10% among individuals seen in outpatient mental health clinics, and about 20% among psychiatric inpatients.
58
Does BPD tend to remit over time, like ASPD?
What symptoms remit the most rapidly?
what two things are associated with lack of recovery?
Borderline personality disorder has long been thought of as a disorder with a poor symptomatic course, which tended to lessen in severity as those with borderline personality disorder entered their 30s and 40s. However, prospective follow-up studies have found that stable remissions of 1–8 years are very common.
Impulsive symptoms of borderline personality disorder remit the most rapidly, while affective symptoms remit at a substantially slower rate.
In contrast, recovery from borderline personality disorder (i.e., concurrent symptomatic remission and good psychosocial functioning) is more difficult to achieve and less stable over time.
Lack of recovery is associated with supporting oneself on disability benefits and suffering from poor physical health.
59
Environmental risk factors for BPD?
Borderline personality disorder has also been found to be associated with high rates of various forms of reported childhood abuse and emotional neglect. However, reported rates of sexual abuse are higher in inpatients than in outpatients with this disorder, suggesting that a history of sexual abuse is as much a risk factor for severity of borderline psychopathology as it is for the disorder itself. In addition, an empirically based consensus has arisen that suggests that a childhood history of reported sexual abuse is neither necessary nor sufficient for the development of borderline personality disorder.
60
Genetic risk factors in BPD?
Borderline personality disorder is about five times more common
among first-degree biological relatives of those with the disorder than in the general population. There is also an increased familial risk for substance use disorders, anxiety disorders, antisocial personality disorder, and depressive or bipolar disorders.
61
Men vs women prevalence of BPD?
While borderline personality disorder is more common among women than men in clinical samples, community samples demonstrate no difference in prevalence between men and women. This discrepancy may reflect a higher degree of help-seeking among women,
leading them to clinical settings.
Clinical characteristics of men and women with borderline personality disorder appear to be similar, with potentially a higher degree of externalizing behaviors in boys and men and internalizing behaviors in girls and women.
62
Comorbidities in BPD
Common co-occurring disorders include depressive and bipolar disorders, substance use disorders, anxiety disorders (particularly panic disorder and social anxiety disorder), eating disorders (notably bulimia nervosa and binge-eating disorder), posttraumatic stress disorder, and attention-deficit/hyperactivity disorder. Borderline personality disorder also frequently co-occurs with the other personality disorders.
63
Although histrionic personality disorder can also be characterized by attention seeking, manipulative behavior, and rapidly shifting emotions, borderline personality disorder is distinguished by: _______
self-destructiveness, angry disruptions in close relationships, and chronic feelings of deep emptiness and loneliness.
64
Paranoid ideas or illusions may be present in both borderline personality disorder and schizotypal personality disorder, but these symptoms are more ________ in borderline personality disorder.
transient, interpersonally reactive, and responsive to external structuring
65
Although paranoid personality disorder and narcissistic personality disorder may also be characterized by an angry reaction to minor stimuli, the ____________________distinguishes these disorders from borderline personality disorder.
relative stability of self-image, as well as the relative lack of physical self-destructiveness, repetitive impulsivity, and profound abandonment concerns
66
Although antisocial personality disorder and borderline personality disorder are both characterized by manipulative behavior, individuals with antisocial personality disorder are manipulative to gain _______, whereas the goal in borderline personality disorder is directed more toward gaining _______.
profit, power, or some other material gratification
the concern of caretakers.
67
Both dependent personality disorder and borderline personality disorder are characterized by fear of abandonment; however, the individual with borderline personality disorder reacts to abandonment with ______________, whereas the individual with dependent personality disorder reacts with ______________. Borderline personality disorder can
further be distinguished from dependent personality disorder by the ____________.
feelings of emotional emptiness, rage, and demands
increasing appeasement and submissiveness and urgently seeks a replacement relationship to provide caregiving and support
typical pattern of unstable and intense relationships
68
DSM V Criteria for Histrionic PD
A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. Is uncomfortable in situations in which he or she is not the center of attention.
2. Interaction with others is often characterized by inappropriate sexually seductive
or provocative behavior.
3. Displays rapidly shifting and shallow expression of emotions.
4. Consistently uses physical appearance to draw attention to self.
5. Has a style of speech that is excessively impressionistic and lacking in detail.
6. Shows self-dramatization, theatricality, and exaggerated expression of emotion.
7. Is suggestible (i.e., easily influenced by others or circumstances).
8. Considers relationships to be more intimate than they actually are.
69
Individuals with _____ personality disorder are uncomfortable or feel unappreciated when they are not the center of attention. Often lively and dramatic, they tend to draw attention to themselves and may initially charm new acquaintances by their enthusiasm, apparent openness, or flirtatiousness. These qualities wear thin, however, as these individuals continually demand to be the center of attention. They commandeer the role of “the life of the party.” If they are not the center of attention, they may do something
dramatic (e.g., make up stories, create a scene) to draw the focus of attention to themselves. This need is often apparent in their behavior with a clinician (e.g., being flattering, bringing gifts, providing dramatic descriptions of physical and psychological symptoms that are replaced by new symptoms each visit).
Histrionic PD
1. Is uncomfortable in situations in which he or she is not the center of attention.
70
This behavior not only is directed toward persons in whom the individual has a sexual or romantic interest but also occurs in a wide variety of social, occupational, and professional relationships beyond what is appropriate for the social context.
dx?
Histrionic PD
2. Interaction with others is often characterized by inappropriate sexually seductive
or provocative behavior.
71
Emotional expression may be shallow and rapidly shifting in what PD?
Histrionic PD
3. Displays rapidly shifting and shallow expression of emotions.
72
They are overly concerned with impressing others by their appearance and expend an excessive amount of time, energy, and money on clothes and grooming. They may “fish for compliments” regarding appearance and may be easily and excessively upset by a critical comment about how they look or by a photograph that they regard as unflattering.
Dx?
Histrionic PD
4. Consistently uses physical appearance to draw attention to self.
73
These individuals have a style of speech that is excessively impressionistic and lacking in detail. Strong opinions are expressed with dramatic flair, but underlying rationales are usually vague and diffuse, without supporting facts and details. For example, an individual with _______ personality disorder may comment that a certain individual is a wonderful human being, yet be unable to provide any specific examples of good qualities to support this opinion.
Histrionic PD
5. Has a style of speech that is excessively impressionistic and lacking in detail.
74
Individuals with this disorder are characterized by self-dramatization, theatricality, and an exaggerated expression of emotion. They may embarrass friends and acquaintances by an excessive public display of emotions (e.g., embracing casual acquaintances with excessive ardor, sobbing uncontrollably on minor sentimental occasions, having temper tantrums). However, their emotions often seem to be turned on and off too quickly to be deeply felt, which may lead others to accuse the individual of faking these feelings.
dx?
Histrionic PD
6. Shows self-dramatization, theatricality, and exaggerated expression of emotion.
75
Their opinions and feelings are easily influenced by others and by current fads. They may be overly trusting, especially of strong authority figures whom they see as magically solving their problems. They have a tendency to play hunches and to adopt convictions quickly.
dx?
Histrionic PD
7. Is suggestible (i.e., easily influenced by others or circumstances).
76
Individuals with this disorder often consider relationships more intimate than they actually are, describing almost every acquaintance as “my dear, dear friend” or referring to physicians met only once or twice under professional circumstances by their first names.
dx?
Histrionic PD
8. Considers relationships to be more intimate than they actually are.
77
Impairment in what PD is the lowest?
Histrionic .
Mostly interpersonal relationships, especially romantic ones, are the most impaired. They're more likely to be divorced or never married.
78
Individuals with this disorder often have impaired relationships with same-sex friends because their sexually provocative interpersonal style may seem a threat to their friends’ relationships. These individuals may also alienate friends with demands for constant attention.
dx?
Histrionic PD
79
They may crave novelty, stimulation, and excitement and have a tendency to become bored with their usual routine. These individuals are often intolerant of, or frustrated by, situations that involve delayed gratification, and their actions are often directed at obtaining immediate satisfaction. Although they often initiate a job or project with great enthusiasm, their interest may lag quickly. Longer-term relationships may be neglected to make way for the excitement of new relationships.
dx?
Histrionic
80
Prevalence of histrionic PD?
Kinda lower than other PDs:
The estimated prevalence of histrionic personality disorder based on a probability subsample from Part II of the National Comorbidity Survey Replication was 0.0%.The prevalence of histrionic personality disorder in the National Epidemiologic Survey on Alcohol and Related Conditions data was 1.8%. A review of five epidemiological studies (four in the United States) found a median prevalence of 0.9%.
81
Sex differences in prevalence of histrionic PD?
Unclear.
In clinical settings, this disorder has been diagnosed more frequently in females; however, the gender ratio is not significantly different from the gender ratio of females within the respective clinical setting. In contrast, some studies using structured assessments report similar prevalence rates among males and females.
82
Individuals with ____ personality disorder and _____ personality disorder share a tendency to be impulsive, superficial, excitement seeking, reckless, seductive, and manipulative, but persons with _____ personality disorder tend to be more exaggerated in their emotions and do not characteristically engage in antisocial behaviors.
histrionic, antisocial.
83
Individuals with histrionic personality disorder are manipulative to gain_____, whereas those with antisocial personality disorder are manipulative to gain ____.
nurturance
profit, power, or some other material gratification.
84
Although individuals with narcissistic personality disorder also crave attention from others, they usually want _____, whereas individuals with histrionic personality disorder are willing to be viewed as fragile or dependent if this is instrumental in getting_______.
praise for their “superiority,”
attention
85
comorbidities in histrionic PD?
Histrionic personality disorder has been associated with higher rates of borderline, narcissistic, paranoid, dependent, and antisocial personality disorders; alcohol and other substance use and misuse; as well as aggression and violence. Histrionic personality disorder is also thought to be related to somatic symptom disorder, functional neurological symptom disorder (conversion disorder), and major depressive disorder.
86
DSM V criteria for Narcissistic PD?
A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
4. Requires excessive admiration.
5. Has a sense of entitlement (i.e., unreasonable expectations of especially
favorable treatment or automatic compliance with his or her expectations).
6. Is interpersonally exploitative (i.e., takes advantage of others to achieve his or
her own ends).
7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs
of others.
8. Is often envious of others or believes that others are envious of him or her.
9. Shows arrogant, haughty behaviors or attitudes.
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They tend to overestimate their abilities and amplify their accomplishments, often appearing boastful and pretentious. They may blithely assume that others attribute the same value to their efforts and may be surprised when the praise they expect and feel they deserve is not forthcoming. Often implicit in the inflated judgments of their own accomplishments is an underestimation or devaluation of the contributions of others.
dx?
Narcissistic
1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
which may be manifest as an exaggerated or unrealistic sense of superiority, value, or capability
88
Individuals with ____ personality disorder are often preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love. They may ruminate about “long overdue” admiration and privilege and compare themselves favorably with famous or privileged people.
Narcissistic
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
89
Individuals with ______ personality disorder believe that they are special or unique and expect others to recognize them as such. They can be surprised or even devastated when the recognition of acclaim they expect and feel they deserve from others is not forthcoming. They may feel that they can only be understood by, and should only associate with, people of high status and may attribute “unique,” “perfect,” or “gifted” qualities to those with whom they associate. Individuals with this disorder believe that their needs are special and beyond the ken of ordinary people. Their own self-esteem is enhanced (i.e., “mirrored”) by the idealized value that they assign to those with whom they associate. They are likely to insist on having only the “top” person (doctor, lawyer, hairdresser, instructor) or being affiliated with the “best” institutions but may devalue the credentials of those who disappoint them.
Narcissistic
3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
90
Their self- esteem is almost invariably very fragile, and their struggle with severe internal self-doubt, self- criticism, and emptiness results in their need to actively seek others’ admiration. They may be preoccupied with how well they are doing and how favorably they are regarded by others. They may expect their arrival to be greeted with great fanfare and are astonished if others do not covet their possessions. They may constantly fish for compliments, often with great charm.
Narcissistic
4. Requires excessive admiration.
91
A sense of entitlement, which is rooted in their distorted sense of self-worth, is evident in these individuals’ unreasonable expectation of especially favorable treatment. They expect to be catered to and are puzzled or furious when this does not happen. For example, they may assume that they do not have to wait in line and that their priorities are so important that others should defer to them, and then get irritated when others fail to assist “in their very important work.” They expect to be given whatever they want or feel they need, no matter what it might mean to others. For example, these individuals may expect great dedication from others and may overwork them without regard for the impact on their lives.
dx?
Narcissistic
5. Has a sense of entitlement (i.e., unreasonable expectations of especially
favorable treatment or automatic compliance with his or her expectations).
92
This sense of entitlement, combined with a lack of understanding and sensitivity to the wants and needs of others, may result in the conscious or unwitting exploitation of others. They tend to form friendships or romantic relationships only if the other person seems likely to advance their purposes or otherwise enhance their self-esteem. They often usurp special privileges and extra resources that they believe they deserve. Some individuals with _____ personality disorder intentionally and purposefully take advantage of others emotionally, socially, intellectually, or financially for their own purposes and gains.
Narcissistic
6. Is interpersonally exploitative (i.e., takes advantage of others to achieve his or
her own ends).
93
Individuals with ____ personality disorder generally have a lack of empathy and are unwilling to recognize or identify with the desires, subjective experiences, and feelings of others.
They tend to have some degree of cognitive empathy
(understanding another person’s perspective on an intellectual level) but lack emotional empathy (directly feeling the emotions that another person is feeling).
These individuals may be oblivious to the hurt their remarks may inflict (e.g., exuberantly telling a former lover that “I am now in the relationship of a lifetime!”; boasting of health in front of someone who is sick). When recognized, the needs, desires, or feelings of others are likely to be viewed disparagingly as signs of weakness or vulnerability.
Narcissistic
7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs
of others.
94
They may begrudge others their successes or possessions, feeling that they better deserve those achievements, admiration, or privileges. They may harshly devalue the contributions of others, particularly when those individuals have received acknowledgment or praise for their accomplishments.
Narcissistic
8. Is often envious of others or believes that others are envious of him or her.
95
Arrogant, haughty behaviors characterize these individuals; they often display snobbish, disdainful, or patronizing attitudes
Narcissistic
9. Shows arrogant, haughty behaviors or attitudes.
96
Low self-esteem with inferiority, vulnerability, and sustained feelings of shame, envy, and humiliation accompanied by self-criticism and insecurity can make individuals with ______ personality disorder susceptible to social withdrawal, emptiness, and depressed mood.
Narcissistic
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Prevalence of Narcissistic PD?
The estimated prevalence of narcissistic personality disorder based on a probability subsample from Part II of the National Comorbidity Survey Replication was 0.0%.The prevalence of narcissistic personality disorder in the National Epidemiologic Survey on Alcohol and Related Conditions data was 6.2%. A review of five epidemiological studies (four in the United States) found a median prevalence of 1.6%.
98
Sex-related differences in prevalence of narcissistic PD?
Among adults age 18 and older diagnosed with narcissistic personality disorder, 50%–75% are men. Gender differences in adults with this disorder include stronger reactivity in response to stress and compromised empathic processing in men as opposed to self-focus and withdrawal in women.
99
How do suicide attempts in people with narcissistic PD differ from those with other PDs?
Suicide attempts in individuals with narcissistic personality disorder tend to be less impulsive and are characterized by higher lethality compared with suicide attempts by individuals with other personality disorders.
100
Comorbidities with narcissitic PD?
Narcissistic personality disorder is associated with depressive disorders (persistent depressive disorder and major depressive disorder), anorexia nervosa, and substance use disorders (especially related to cocaine).
Histrionic, borderline, antisocial, and paranoid personality disorders may also be associated with narcissistic personality disorder.
101
DSM V Criteria for Avoidant Personality Disorder?
A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
1. Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection.
2. Is unwilling to get involved with people unless certain of being liked.
765
3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.
4. Is preoccupied with being criticized or rejected in social situations.
5. Is inhibited in new interpersonal situations because of feelings of inadequacy.
6. Views self as socially inept, personally unappealing, or inferior to others.
7. Is unusually reluctant to take personal risks or to engage in any new activities
because they may prove embarrassing.
102
Essential feature of avoidant personality disorder?
The essential feature of avoidant personality disorder is a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation that begins by early adulthood and is present in a variety of contexts.
103
Individuals with ____ personality disorder avoid work activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection. Offers of job promotions may be declined because failure to manage the new responsibilities might result in criticism from coworkers.
Avoidant PD
1. Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection.
104
These individuals avoid making new friends unless they are certain they will be liked and accepted without criticism (Criterion 2). Until they pass stringent tests proving the contrary, other people are assumed to be critical and disapproving. Individuals with this disorder are highly avoidant of group activities.
Avoidant PD
2. Is unwilling to get involved with people unless certain of being liked.
105
Interpersonal intimacy is often difficult for these individuals, although they are able to establish intimate relationships when there is assurance of uncritical acceptance. They may act with restraint, be reluctant to talk about themselves, and withhold intimate feelings for fear of being exposed, ridiculed, or shamed.
Avoidant PD
3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.
106
Because individuals with this disorder are preoccupied with being criticized or rejected in social situations, they may have a markedly low threshold for detecting such reactions. If someone is even slightly disapproving or critical, they may feel extremely hurt. They tend to be shy, quiet, inhibited, and “invisible” because of the fear that any attention would be critical or rejecting. They expect that no matter what they say, others will see it as “wrong,” and so they may say nothing at all. They react strongly to subtle cues that are suggestive of mockery or derision, and may misinterpret a neutral gesture or statement as critical or rejecting. Despite their longing to be active participants in social life, they fear placing their psychological welfare in the hands of others.
Avoidant PD
4. Is preoccupied with being criticized or rejected in social situations.
107
Individuals with _______ personality disorder are inhibited in new interpersonal situations because they feel inadequate and have low self-esteem
Avoidant PD
5. Is inhibited in new interpersonal situations because of feelings of inadequacy.
108
These individuals believe themselves to be socially inept, personally unappealing, or inferior to others (Criterion 6). Doubts concerning social competence and personal appeal may be most intense for some individuals in settings involving interactions with strangers.
But many others report more
difficulties with repeated interaction, when sharing of personal information would normally occur, thus, in the individual’s perception, increasing the chances that their inferiority would be revealed and that they would be rejected. When commencing a new ongoing social or occupational commitment requiring repeated interpersonal interaction, individuals may over weeks or months develop a growing conviction that others or colleagues view them as inferior or lacking worth, resulting in intolerable distress or anxiety that prompts resignation. Thus, a history of repeated job changes may be present.
Avoidant PD
6. Views self as socially inept, personally unappealing, or inferior to others.
109
Individuals with this disorder are unusually reluctant to take personal risks or to engage in any new activities because these may prove embarrassing. They are prone to exaggerate the potential dangers of ordinary situations, and a restricted lifestyle may result from their need for certainty and security.
Avoidant PD
7. Is unusually reluctant to take personal risks or to engage in any new activities
because they may prove embarrassing.
110
Individuals with avoidant personality disorder often vigilantly appraise the movements and expressions of those with whom they come into contact. They are likely to
misinterpret social responses as critical, which in turn confirms their self-doubts.
Avoidant PD
111
They are described by others as being “shy,” “timid,” “lonely,” and “isolated.”
Avoidant PD
112
Prevalence of Avoidant PD?
The estimated prevalence of avoidant personality disorder based on a probability subsample from Part II of the National Comorbidity Survey Replication was 5.2%. The prevalence of avoidant personality disorder in the National Epidemiologic Survey on Alcohol and Related Conditions was 2.4%. A review of six epidemiological studies (four in the United States) found a median prevalence of 2.1%.
113
When does avoidant PD behaviour tend to start?
Does avoidant PD decrease, increase, or stay the same intensity with age?
The avoidant behavior often starts in infancy or childhood with shyness, isolation, and fear of strangers and new situations. Although shyness in childhood is a common precursor of avoidant personality disorder, in most individuals it tends to gradually dissipate as they get older. In contrast, individuals who go on to develop avoidant personality disorder may become increasingly shy and avoidant during adolescence and early adulthood, when social relationships with new people become especially important.
There is some evidence that in adults, avoidant personality disorder tends to become less evident or to remit with age; the prevalence in adults older than 65 years has been estimated at 0.8%.
This diagnosis should be used with great caution in children and adolescents, for whom shy and avoidant behavior may be developmentally appropriate.
114
Men vs women prevalence of avoidant PD?
Avoidant personality disorder appears to be more common in women than in men in community surveys. This gender difference in prevalence is small but consistently found in large population- based samples.
115
How do you tell avoidant PD and social anxiety disorder apart?
There appears to be a great deal of overlap between avoidant personality disorder and social anxiety disorder. It has been suggested that they may represent different manifestations of similar underlying problems, or avoidant personality disorder may be a more severe form of social anxiety disorder.
However, differences have also been described, especially in relation to self-concept (such as self-esteem and the sense of inferiority in avoidant personality disorder); the latter is indirect evidence as it shows that negative self-concept in social anxiety disorder may be unstable and thus less pervasive and entrenched than in avoidant personality disorder.
Additionally, studies have shown that avoidant personality disorder frequently occurs in the absence of social anxiety disorder, and some separate risk factors have been identified, providing support for retaining two separate diagnostic categories.
116
Both avoidant personality disorder and dependent personality disorder are characterized by _________
feelings of
inadequacy, hypersensitivity to criticism, and a need for reassurance.
117
Similar behaviors (e.g., unassertiveness) and attributes (e.g., low self-esteem and low self-confidence) may be observed in both _____ personality disorder and _____ personality disorder.
The motivations behind similar behaviors may be quite different. For example, the unassertiveness in ____ personality disorder is described as more closely related to fears of _____, whereas in____ personality disorder it is motivated by the desire _______.
dependent, avoidant
avoidant, being rejected or humiliated
dependent, to avoid being left to fend for oneself.
118
how to tell avoidant PD and dependent PD apart?
avoidance of social proximity in avoidant personality disorder but proximity-seeking in dependent personality disorder.
However, avoidant personality disorder and dependent personality disorder may be particularly likely to co-occur.
119
Co-morbidities in avoidant PD?
Other disorders that are commonly diagnosed with avoidant personality disorder include depressive disorders and anxiety disorders, especially social anxiety disorder.
Avoidant personality disorder also tends to be diagnosed with schizoid personality disorder.
Avoidant personality disorder is associated with increased rates of substance use disorders at a similar rate to the generalized form of social anxiety disorder.
120
DSM V criteria for Dependent personality disorder?
A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
2. Needs others to assume responsibility for most major areas of his or her life.
3. Has difficulty expressing disagreement with others because of fear of loss of
support or approval. (Note: Do not include realistic fears of retribution.)
4. Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or
energy).
5. Goes to excessive lengths to obtain nurturance and support from others, to the
point of volunteering to do things that are unpleasant.
6. Feels uncomfortable or helpless when alone because of exaggerated fears of
being unable to care for himself or herself.
7. Urgently seeks another relationship as a source of care and support when a
close relationship ends.
8. Is unrealistically preoccupied with fears of being left to take care of himself or
herself.
121
Essential feature of dependent PD?
The essential feature of dependent personality disorder is a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation.
The dependent and submissive behaviors are designed to elicit caregiving and arise from a self-perception of being unable to function adequately without the help of others.
122
Individuals with ______ personality disorder have great difficulty making everyday decisions (e.g., what color shirt to wear to work or whether to carry an umbrella) without an excessive amount of advice and reassurance from others
Avoidant PD
1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
123
Adults with this disorder typically depend on a parent or spouse to decide where they should live, what kind of job they should have, and which neighbors to befriend.
Adolescents with this disorder may allow their parent(s) to decide what they should wear, with whom they should associate, how they should spend their free time, and what school or college they should attend.
Avoidant PD
2. Needs others to assume responsibility for most major areas of his or her life.
124
These individuals feel so unable to function alone that they will agree with things that they feel are wrong rather than risk losing the help of those to whom they
look for guidance.
They do not express anger toward others whose support and nurturance they need for fear of alienating them.
Avoidant PD
3. Has difficulty expressing disagreement with others because of fear of loss of
support or approval.
(Note: Do not include realistic fears of retribution: If the individual’s concerns regarding the consequences of expressing disagreement are realistic (e.g., realistic fears of retribution from an abusive spouse), the behavior should not be considered to be evidence of dependent personality disorder.)
125
They lack self-confidence and believe that they need help to begin and carry through tasks. They will wait for others to start things because they believe that as a rule others can do them better. These individuals are convinced that they are incapable of functioning independently and present themselves as inept and requiring constant assistance. They are, however, likely to function adequately if given the assurance that someone else is supervising and approving.
Avoidant PD
4. Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy).
There may be a fear of becoming or appearing to be more competent, because they may believe that this will lead to loss of support. Because they rely on others to handle their problems, they often do not learn the skills of independent living, thus perpetuating dependency.
126
Individuals with dependent personality disorder may go to excessive lengths to obtain nurturance and support from others, even to the point of volunteering for unpleasant tasks if such behavior will bring the care they need (Criterion 5).
They are willing to submit to what others want, even if the demands are unreasonable.
Their need to maintain an important bond will often result in imbalanced or distorted relationships.
They may make extraordinary self-sacrifices or tolerate verbal, physical, or sexual abuse.
Avoidant PD
5. Goes to excessive lengths to obtain nurturance and support from others, to the
point of volunteering to do things that are unpleasant.
(It should be noted that this behavior should be considered evidence of dependent personality disorder only when it can clearly be established that other options are available to the individual.)
127
Individuals with this disorder feel uncomfortable or helpless when alone because of their exaggerated fears of being unable to care for themselves (Criterion 6).
Avoidant PD
6. Feels uncomfortable or helpless when alone because of exaggerated fears of
being unable to care for himself or herself.
128
Their belief that they are unable to function in the absence of a close relationship motivates these individuals to become quickly and indiscriminately attached to another individual.
Avoidant PD
7. Urgently seeks another relationship as a source of care and support when a
close relationship ends.
129
They see themselves as so totally dependent on the advice and help of an important other person that they worry about losing the support of that person when there are no grounds to justify such fears.
Avoidant PD
8. Is unrealistically preoccupied with fears of being left to take care of him or herself.
130
They take criticism and disapproval as proof of their worthlessness and lose faith in themselves. They may seek overprotection and dominance from others.
dx?
Avoidant PD
131
Occupational functioning may be impaired if independent initiative is required. They may avoid positions of responsibility and become anxious when faced with decisions.
dx?
Avoidant PD
132
Prevalence of avoidant PD?
The estimated prevalence of dependent personality disorder based on a probability subsample from Part II of the National Comorbidity Survey Replication was 0.6%. The
prevalence of dependent personality disorder in the National Epidemiologic Survey on Alcohol and Related Conditions was 0.5%. A review of six epidemiological studies (four in the United States) found a median prevalence of 0.4%.
133
Individuals with ___ personality disorder are often characterized by pessimism and self- doubt and tend to belittle their abilities and assets.
Avoidant PD
134
Women vs men prevalence in dependent PD?
In clinical and community settings, dependent personality disorder has been diagnosed more frequently in women compared with men.
135
Both ____ personality disorder and ____ personality disorder are characterized by fear of abandonment; however, the individual with ____ personality disorder reacts to abandonment with feelings of _____, whereas the individual with______ personality disorder reacts with _____.
dependent, borderline
borderline, emotional emptiness, rage, and demands
dependent, increasing appeasement and submissiveness and urgently seeks a replacement relationship to provide caregiving and support.
136
individuals with ____ personality disorder have such a strong fear of humiliation and rejection that they withdraw until they are certain they will be accepted. In contrast, individuals with _____ personality disorder have a pattern of seeking and maintaining connections to important others, rather than avoiding and withdrawing from relationships.
avoidant
dependent
137
Comorbidities in Dependent PD?
There may be an increased risk of depressive disorders, anxiety disorders, and adjustment disorders. Dependent personality disorder often co-occurs with other personality disorders, especially borderline, avoidant, and histrionic personality disorders.
138
what might predispose someone to developing dependent PD?
Chronic physical illness or persistent separation anxiety disorder in childhood or adolescence may predispose the individual to the development of this disorder.
139
DSM-V Criteria for OCPD?
A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.
2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).
3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).
4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).
772
5. Is unable to discard worn-out or worthless objects even when they have no sentimental value.
6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.
7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.
8. Shows rigidity and stubbornness.
140
hey are excessively careful and prone to repetition, paying extraordinary attention to detail and repeatedly checking for possible mistakes, losing track of time in the process. For example, when such individuals misplace a list of things to be done, they will spend an inordinate amount of time looking for the list rather than spending a few moments trying their best to recreate it from memory and proceeding to accomplish the tasks. They dismiss the fact that other people tend to become very annoyed at the delays and inconveniences that result from this behavior because they preferentially respond to either their anxiety about making a mistake or their insistence on how things should be done. Time is poorly allocated, and the most important tasks are left to the last moment.
OCPD
1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.
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For example, the completion of a written report is delayed by numerous time-consuming rewrites that all come up short of “perfection.” Deadlines are routinely missed or the individual has a pattern of exerting extraordinary effort (e.g., working through the night, skipping meals) in order to make the deadline at the last moment, and aspects of the individual’s life that are not the current focus of activity may fall into disarray.
OCPD
2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).
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hey often feel that they do not have time to take an evening or a weekend day off to go on an outing or to just relax. They may keep postponing a pleasurable activity, such as a vacation, so that it may never occur. When they reluctantly take time for leisure activities or vacations, they are very uncomfortable unless they have taken along something to work on so they do not “waste time.” There may be a great concentration on household chores (e.g., repeated excessive cleaning so that “one could eat off the floor”). If they spend time with friends, it is likely to be in some kind of formally organized activity (e.g., sports). Hobbies or recreational activities are approached as serious tasks or with methodical intensity, requiring careful organization and hard work to master. The emphasis is on perfect performance. These individuals turn play into a structured work-like task (e.g., correcting an infant for not putting rings on the post in the right order; telling a toddler to ride their tricycle in a straight line; turning a baseball game into a harsh “lesson”).
OCPD
3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).
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They may force themselves and others to follow rigid moral principles and very strict standards of performance. They may also be mercilessly self-critical about their own
mistakes or harshly judgmental of others’ moral or ethical missteps. Individuals with this disorder are rigidly deferential to authority and rules and insist on quite literal compliance, with no rule bending for extenuating circumstances. For example, the individual will not lend a dollar to a friend who is short of the fare needed to get on a bus because “neither a borrower nor a lender be” or because it would be “bad” for the friend’s character. These qualities should not be accounted for by the individual’s cultural or religious identification.
OCPD
4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).
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Individuals with this disorder may be unable to discard worn-out or worthless objects, even when they have no sentimental value (Criterion 5). Often these individuals will admit to being “pack rats.” They regard discarding objects as wasteful because “you never know when you might need something.” The clutter may also result from an accumulation of partially read learning material or unfinished projects that the individual intends to get to someday but that have been sidelined because of procrastination and/or a meticulous yet slow work style. These individuals will become upset if someone tries to get rid of the things they have saved. Their spouses or roommates may complain about the amount of space taken up by old parts, piles of reading material, broken appliances, and so on.
OCPD
5. Is unable to discard worn-out or worthless objects even when they have no sentimental value.
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They stubbornly and unreasonably insist that everything be done their way and that people conform to their way of doing things. They often give very
detailed instructions about how things should be done (e.g., there is one and only one way to mow the lawn, wash the dishes, load the dishwasher, build a doghouse), even to the point of micromanaging others, and are surprised and irritated if others suggest creative alternatives. At other times they may reject offers of help even when behind schedule because they believe no one else can do it right.
OCPD
6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.
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Individuals with this disorder may be miserly and stingy (having difficulty spending money on both themselves and others) and maintain a standard of living far below what they can afford, believing that spending must be tightly controlled to provide for future catastrophes.
OCPD
7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.
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Individuals with this disorder are so concerned about having things done the one “correct” way that they have trouble going along with anyone else’s ideas. These individuals plan ahead in meticulous detail and are unwilling to consider changes to these plans or their usual routines. Totally wrapped up in their own perspective, they have difficulty acknowledging the viewpoints of others. Friends and colleagues may become frustrated by this constant rigidity. Even when individuals with obsessive-compulsive personality disorder recognize that it may be in their interest to compromise, they may stubbornly refuse to do so, arguing that it is “the principle of the thing.”
OCPD
8. Shows rigidity and stubbornness.
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Individuals with this disorder have difficulty relating to and sharing emotions. For example, they may express affection in a highly controlled or stilted fashion and may be very uncomfortable in the presence of others who are emotionally expressive. Their everyday relationships have a formal and serious quality, and they may be stiff in situations in which others would smile and be happy (e.g., greeting a lover at the airport). They carefully hold themselves back until they are sure that whatever they say will be perfect. They may be preoccupied with logic and intellect and intolerant of displays of emotion in others. They often have difficulty expressing tender feelings, rarely paying compliments.
OCPD
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Prevalence of OCPD
The estimated prevalence of obsessive-compulsive personality disorder based on a probability subsample from Part II of the National Comorbidity Survey Replication was 2.4%. The prevalence of obsessive-compulsive personality disorder in the National Epidemiologic Survey on Alcohol and Related Conditions was 7.9%. A review of five epidemiological studies (three in the United States) found a median prevalence of 4.7%.
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Men woman prevalence of OCPD?
In large population-based studies, obsessive-compulsive personality disorder appears to be equally prevalent in men and women.
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Comorbidities in OCPD?
Individuals with anxiety disorders (e.g., generalized anxiety disorder, separation anxiety disorder, social anxiety disorder, specific phobias) and OCD have an increased likelihood of having a personality disturbance that meets criteria for obsessive-compulsive personality disorder.
Even so, it appears that the majority of individuals with OCD do not have a pattern of behavior that meets criteria for this personality disorder. Many of the features of obsessive- compulsive personality disorder overlap with “type A” personality characteristics (e.g., preoccupation with work, competitiveness, time urgency), and these features may be present in individuals at risk for myocardial infarction.
There may be an association between obsessive- compulsive personality disorder and depressive and bipolar disorders and eating disorders.
