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Flashcards in Personality Disorders Deck (49):
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What 4 qualities determine personality 

•Temperament - “nature”

•Development – effect of “nurture” on biology

•Character – “nurture”

•Psyche – self awareness (the ability to learn, adapt, change) 

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“Nature”
Apparent before traditional learning occurs

50% of personality is related to temperment 

Temperament 

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Negative events in early childhood (typically repeated, chronic abuse or neglect) can physiologically alter the limbic system and cause permanent effects on emotional arousal, etc. 

Development 

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unconscious mental processes that the ego uses to resolve conflicts...” between instinct (id), reality, important persons, conscience (superego) 

Defense Mechanisms 

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What is the paradigm of defense mechanism

Instincts and drive (Id)

and

Conscience, reality, important persons (Super Ego)

feed into Defense mechanism =Ego

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Info on defense mechanisms

In other words, they help you cope with difficult situations when your instinct is to do one thing (punch someone) and your mind/heart/conscience wants to do another (play nice). 

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When defense mechanisms work vs not so much

Defense mechanisms are universal, in everyone. They work!

When they remain rigid, despite changing situations, they don’t work! 

When they are effective, they help resolve anxiety and depression. So changing it increases anxiety.

A major reason not to change!!! 

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____– ignoring reality (can be adaptive dealing with serious illness or can get in the way of treatment)

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

•____– intentionally (consciously) pushing down to deal with now 

Denial

Dissociation

Suppression

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When is Personality a Disorder?

a relatively stable and enduring set of characteristic behavioral and emotional traits.” *

•Normally, it is flexible and adaptable

•“When disordered, it is ...maladaptive, deeply ingrained , and often distressing for both the patient and significant others.” 

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Personailty is disordered when: 

Personality is “disordered” when

It’s ingrained and inflexible

It gets in the way (of relationships, functioning)

It’s relatively stable
It distresses people around them 

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What's the difference between Ego-syntonic vs. Ego-dystonic 

Personality Disorders are often ego- syntonic rather than ego-dystonic.

Ego-syntonic means “acceptable to the ego” i.e. it doesn’t bother them, it bothers others, as opposed to

ego-dystonic – uncomfortable 

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OCPD – , perfection is expectation, not bothersome = 

OCD – , “I know it doesn’t make sense, but...” =

ego-syntonic

ego-dystonic

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Epidemiology of personality disorders 

10-18% prevalence in the general population – i.e. your office

30-50% prevalence in psychiatric outpatient populations

Over 50% on inpatient psychiatric unit

Of patients with (Axis I) disorders, 34% have co-morbid personality disorder 

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Personality Disorders, in general, are _____ in men and women

Some personality d/o tend to be diagnosed more in one gender (borderline, histrionic for females, narcissistic, antisocial for males) - ?some validity, some stereotype 

equally common

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Describe Cluster A personality disorder

more detached, eccentric

Schizoid PD

Schizotypal PD

Paranoid PD 

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Emotionally detached, loners Don’t want relationships 

schizoid P.D; Cluster A

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Prevelance of Schizoid PD

Prevalence – anywhere from “uncommon” to 7.5% of general population

Males diagnosed twice as much as females

Higher incidence of psychosis in relatives 

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How is Schizoid PD different from schizophrenia?

Differentiated from schizophrenia by absence of psychotic symptoms (hallucinations, delusions, thought disorder) 

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cognitive, perceptual and behavioral eccentricities. ...frequently embrace beliefs, such as telepathy, clairvoyance, and magical thinking, to a degree that exceeds cultural and subcultural norms 

Schizotypal Personality Disorder 

Cluster A

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Epidemiology of Schizotypal PD

•3% of population

•Highly genetic (33% concordance in monozygotic twins vs. 4% in dizygotic)

•Increased risk in biological relatives of schizophrenics 

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Long-standing suspiciousness and mistrust

of people (with no basis for this mistrust) Read threats into non-threatening

situations
Pathologically jealous if in a relationship 

Paranoid Personality Disorder  (cluster A)

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Epidemiology of Paranoid PD

0.5-2.5% of population
Rarely seek treatment themselves

Males diagnosed more than females 

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How do we differentiate Paranoid PD from schizophrenia?

Differentiated from schizophrenia by absence of hallucinations or thought disorder, higher functioning and non-bizarre paranoia 

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Antisocial

Borderline

Histrionic

Narcissistic 

CLUSTER B –
MORE DRAMATIC, IMPULSIVE 

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Frantic efforts to avoid real or imagined abandonment (interpersonal)

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

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

Borderline Personality Disorder  (cluster B)

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A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and

devaluation (interpersonal, affective)

 you are the best doctor ever after you prescribe Vicodin for minor knee pain. When you appropriately refuse to refill the prescription one month later you become the worst physician ever 

Borderline Personality Disorder  (cluster B)

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Affective instability due to marked reactivity of mood, “mood swings”, (can be argumentative one moment, depressed the next, and later complain of having no feelings) (affect)

Chronic feelings of emptiness

Recurrent suicidal behavior, threats or self mutilating behavior (impulse control) 

seen in Borderline P.D. (cluster B)

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Epidemiology of Borderline Personality Disorder

1-2% of population

Females diagnosed more commonly than males

High genetic load. More MDD and substance abuse in relatives.

Multiple suicide attempts, up to 10% complete suicide 

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repetative unlawful acts and socially irresponsible behaviors that began prior to age 15.

...so unconcerned with the feelings and rights of others that they are morally bankrupt and lack a sense of remorse. 

Antisocial Personality Disorder  (cluster B)

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What characteristics do we see in Antisocial PD

• Deceitful, impulsive

• Irritability and aggressiveness

• Reckless disregard for safety of self or others

• Consistent irresponsibility (doesn’t honor financial obligations)

• Lack of remorse 

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What is the difference between asocial and antisocial?

What's the epidemiology of Antisocial PD?

Often confused in lay terms, taken to mean “asocial”.

Antisocial = sociopath
3% of male population, 1% of female population

High genetic load, 5x more common in relatives with the disorder 

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pervasive overconcern with appearance and attention, exaggerated emotional response, poor frustration tolerance that ends in outbursts, and impressionistic speech that lacks detail. ”

“View physical attractiveness as the core of their existence 

Histrionic Personality Disorder (cluster B)

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Epidemiology of histrionic PD

Believed to occur in 2-3% of population

Females diagnosed more than males 

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Characterized by a heightened sense of self-importance, grandiose feelings and lack of empathy

Preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love

Arrogant, entitled, and often envious

Require excessive admiration. Take advantage of others to achieve their own ends 

Narcissistic Personality Disorder  (cluster B)

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What are my 3 Cluster C personality disorders?

OCPD

Avoidant

Dependent 

(more anxious )

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Become so preoccupied with details and rules that the major point of an activity is lost

Display perfectionism that interferes with task completion (taking hours to do notes because it has to be perfect)

Have inflexible values and are overly conscientious 

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Epidemiology of OCPD

 M>F

More common among first degree relatives with OCPD

Tend to be oldest children 

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What is the difference from OCD vs OCPD?

Defenses of person with OCPD– rationalizing, intellectualizing, reaction formation, undoing, controlling

NOT the same as OCD – ego dystonic, however, under stress, OCPD can develop OCD symptoms 

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Show extreme sensitivity to rejection which may lead to a socially withdrawn life

Although shy, they have a great desire for relationships (which differentiates them from schizoid p.d.) 

Avoidant Personality Disorder (cluster C)

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Subordinate their own needs to those of others

Lack self-confidence and can’t make decisions without excessive advice and reassurance

Doesn’t speak up b/c may lose support or approval

Uncomfortable being alone. Urgently seeks another relationship when a close one ends. 

Dependent Personality Disorder(cluster C)

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Epidemiology of Dependent PD

• Females diagnosed more than males

• Tend to be youngest children 

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What are the tx options for personality disorders?

Psychodynamic psychotherapy – to change the defenses

Supportive if too unstable or minimal insight

Behavioral (DBT) if self destructive behavior

Psychopharm – to target symptoms. Serotonin for impulse control, rejection sensitivity, mood stabilizer for lability, affect dysregulation 

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is an interplay between genetic factors (temperament), environmental factors (character) and biological factors (development) and psyche 

Personality

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 are adaptive and universal. When they become rigid or inappropriate for reality, they may become symptoms

 

Defense mechanisms

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 ____tends to be more detached and eccentric
 _____ tends to be more dramatic & self-focused
 _____ tends to be more anxious 

Cluster A 

Cluster B

Cluster C