Personality Disorders

Question 1

Personality

Answer 1

A relatively stable & enduring set of characteristic behavioral & emotional traits

Question 2

What are the 4 determinants of personality?

How are they defined?

Answer 2

• Temperament
  
  • “nature”
  • Apparent before traditional learning occurs
  • 50% of personality is related to temperament
• Development
  
  • Effect of “nurture” on biology
  • Negative events in early childhood (typically repeated, chronic abuse or neglect) can physiologically alter the limbic system & cause permanent effects on emotional arousal, etc.
• Character – “nurture”
• Psyche – self-awareness (the ability to learn, adapt, change)

Question 3

What are defense mechanisms?

Answer 3

Unconscious mental processes that the ego uses to resolve conflicts

Question 4

Defense mechanisms are between________, reality, important persons, and ___________.

When they remain rigid, despite changing, they _______ _______.

Changing it increases ______.

Answer 4

instinct (id)

conscience (superego)

don’t work

anxiety

Question 5

What are 3 examples of defense mechanisms?

Answer 5

• Denial
• Dissociation
• Suppression

Question 6

Ignoring reality
Adaptive dealing w/ serious illness
Can get in the way of treatment

Answer 6

Denial

Question 7

Mentally separating part of one’s consciousness from real life events

Answer 7

Dissociation

Question 8

Intentionally (consciously) pushing down to deal w/ now

Answer 8

Suppression

Question 9

Define personality disorder

Answer 9

• Relatively stable & enduring set of characteristic behavioral & emotional traits
• Normally flexible & adaptable
• When disordered, it is maladaptive, deeply ingrained & often distressing for both the patient & significant others

Question 10

Personality is “disordered” when….

Answer 10

• It’s ingrained & inflexible
• It gets in the way of relationships/functioning
• It’s relatively stable
• It distresses people around them

Question 11

Ego-syntonic vs. Ego-dystonic

Answer 11

ego-syntonic > ego-dystonic

• Ego-syntonic
  
  • “acceptable to the ego”
  • It doesn’t bother them, it bothers others
• Ego-dystonic – uncomfortable

Question 12

OCPD is (ego-syntonic/ego-dystonic)

OCD is (ego-syntonic/ego-dystonic)

Answer 12

OCPD = ego-syntonic

OCD = ego-dystonic

Question 13

Personality Disorders

______% prevalence in general population (office)
______% prevalence in psychiatric outpatient populations
>____% on inpatient psychiatric unit

Answer 13

10-18% prevalence in general population (office)
30-50% prevalence in psychiatric outpatient populations
>50% on inpatient psychiatric unit

Question 14

What are the gender trends in personality disorders?

What diseases are more common in men? women?

Answer 14

Men = Women

• Females: borderline, histrionic
• Males: Narcissistic, anti-social
• Some validity, some stereotype

Question 15

Personality Disorders

• Cluster A
• Cluster B
• Cluster C

Answer 15

• Cluster A = more detached, eccentric
• Cluster B = more dramatic, impulsive
• Cluster C = more anxious

Question 16

What are some examples of Cluster A disorders?

Answer 16

• Schizoid PD
• Schizotypal PD
• Paranoid PD

Question 17

Schizoid PD

Definition

Prevalence

Difference from Schizophrenia

Answer 17

• Emotionally detached, loners
• Don’t want relationships
• Prevalence – anywhere from “uncommon” to 7.5% of general population
• Males 2X as much as females
• Higher incidence of psychosis in relatives
• Differentiated from schizophrenia by absence of psychotic symptoms (hallucinations, delusions, thought disorder)

Question 18

Schizotypal PD

Definition

Prevalence

Answer 18

• “cognitive, perceptual & behavioral eccentricities…frequently embrace beliefs, such as telepathy, clairvoyance & magical thinking, to a degree that exceeds cultural & subcultural norms”
• 3% of population
• Highly genetic
• 33% monozygotic twins
• 4% dizygotic twins
• Increased risk in biological relatives of schizophrenics

Question 19

Paranoid PD

Definition

Prevalence

Differentiation from Schizophrenia

Answer 19

• Long-standing suspiciousness & mistrust of people
• No basis for this mistrust
• Read threats into non-threatening situations
• Pathologically jealous if in a relationship
• 0.5-2.5% of population
• Rarely seek treatment themselves
• Males > Females
• Differentiated from schizophrenia by absence of hallucinations or though disorder, higher functioning & non-bizarre paranoia

Question 20

What are some examples of Cluster B disorders?

Answer 20

• Antisocial
• Borderline
• Histrionic
• Narcissistic

Question 21

“repetitive unlawful acts & socially irresponsible behaviors that began prior to age 15…so unconcerned w/ the feelings & rights of others that they are morally bankrupt & lack of a sense of remorse”

Answer 21

Antisocial Disorder

Question 22

Antisocial

Definition

Answer 22

• Deceitful, impulsive
• Irritability & aggressiveness
• Reckless disregard for safety of self or others
• Consistent irresponsibility (doesn’t honor financial obligations)
• Lack of remorse
• Often confused in lay terms, taken to mean “antisocial”
• Antisocial = sociopath

Question 23

Antisocial

Prevalence

Answer 23

• 3% of male population, 1% of female population
• High genetic load
• 5X more common in relatives w/ disorder

Question 24

Getting distraught if a spouse is 5 min late getting home from work

Placing dozens of phone calls to one’s therapist before the therapist goes on vacation

Answer 24

Borderline Disorder

Question 25

**Borderline ** Definition Relationships Mood

Answer 25

* **Frantic efforts to avoid real or imagined abandonment (interpersonal)** * A pattern of unstable & intense interpersonal relationships characterized by alternating btwn extremes of _idealization_ & _devaluation_ (interpersonal, affective) * Affective instability due to marked reactivity of mood * _“mood swings”_ * Argumentative one moment, depressed the next * Later complain of having no feelings (affect) * Chronic feelings of emptiness * Recurrent **suicidal behavior**, threats or self-mutilating behavior (impulse control)

Question 26

**Borderline** Prevalence

Answer 26

* 1-2% of population * _Females \> Males_ * **High genetic load** * More MDD & substance abuse in relatives * Multiple _suicide_ attempts (up to 10% complete)

Question 27

**Histrionic** Definition Prevalence

Answer 27

* “…pervasive **overconcern** w/ appearance & attention, **exaggerated & emotional response**, poor frustration tolerance that ends in outbursts, & impressionistic speech that lacks detail” * “View physical attractiveness as the core of their existence” * Believed to occur in 2-3% of the population * _Females \> Males _

Question 28

**Narcissistic** Definition Preoccupations

Answer 28

* Characterized by a **heightened sense of self-importance, grandiose feelings & lack of empathy** * Preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love * Arrogant, entitled & often envious * Require excessive admiration * _Take advantage of others_ to achieve their own ends

Question 29

What are some examples of **Cluster C** disorders?

Answer 29

* OCPD * Avoidant * Dependent

Question 30

**OCPD** Definition

Answer 30

* Become so **preoccupied w/ details & rules** that the major point of an activity is lost * Display **perfectionism** that interferes w/ task completion (taking hrs to do notes because it has to be perfect) * Have **inflexible** values & are overly conscientious

Question 31

**OCPD** Prevalence Defenses Difference from OCD

Answer 31

* _Males \> Females_ * More common among 1st degree relatives w/ OCPD * **Tend to be oldest children** * _Defenses_ – rationalizing, intellectualizing, reaction formation, undoing, controlling * NOT the same as OCD – **ego dystonic** * However, under stress, can develop OCD symptoms

Question 32

**Avoidant** Definition

Answer 32

* **Show extreme sensitivity to rejection** which may lead to a socially withdrawn life * Although shy, they have a _great desire for relationships_ * Differentiates from schizoid PD

Question 33

**Dependent** Definition Prevalence

Answer 33

* Subordinate their own needs to those of others * **Lack self-confidence & can’t make decisions w/o excessive advice & reassurance** * Doesn’t speak up b/c may lose support or approval * _Uncomfortable being alone_ * Urgently seeks another relationship when a close one ends * Females \> Males * **Youngest children**

Question 34

What are the available **treatments** for personality disorder?

Answer 34

* **Psychodynamic psychotherapy** to change the defenses * Supportive if too unstable or minimal insight * Behavioral (DBT) if self-destructive behavior * **Psychopharm** * Target symptoms * _Serotonin_ – impulse control, rejection sensitivity, mood stabilizer for lability, affect dysregulation