Personality Disorders

Question 1

True or false: people with personality disorders typically have good insight into their problems.

Answer 1

false - usually have poor insight as their symptoms are usually ego-syntonic or viewed as immutable

Question 2

What are the criteria for a personality disorder in general?

Answer 2

a pattern of behavior/inner experience that deviates from the person’s culture

pattern is pervasive and inflexible in a broad range of situations and it’s been stable since adolescence or early adulthood

Question 3

What are the cluster A personality disorders?

Answer 3

The weird: schizoid, schizotypal and paranoid

Question 4

What are the cluster B personality disorders?

Answer 4

The wild: antisocial, borderline, histrionic, and narcissistic

Question 5

What are the cluster C personality disorders?

Answer 5

The worried: avoidant, dependent, and obsessive-compulsive

Question 6

Describe paranoid personality disorder.

Answer 6

patients have a pervasive distrust and suspiciousness of others, often interpreting motives as malevolent

tend to blame their own problems on others and seem angry and hostile.

often characterized as pathologically jealous, leading them to think their sexual partners are cheating on them

Question 7

Paranoid personality disorder occurs more often in what gender?

Answer 7

males

Question 8

What should be on the differential diagnosis for paranoid personality disorder?

Answer 8

paranoid schizophrenia

social disenfranchisement and social isolation (so often misdiagnosed in minority groups, immigrants and deaf people!)

Question 9

What are the criteria for schizoid personality disorder?

Answer 9

a pattern of voluntary social withdrawal and restricted range of emotional expression with four or more of the following:

1. neither enjoying nor desiring close relationships
2. choosing solitary activities
3. little interest in sex
4. taking pleasure in few activities
5. few close friends if any
6. indifferent to praise or criticism
7. emotional coldness, detachment or flat affect

Question 10

Which one has a history incidence in families with schizophrenics: paranoid PD or schizoid PD?

Answer 10

paranoid

Question 11

What should be on the differential for schizoid PD?

Answer 11

paranoid schizophrenia (but they lack the fixed delusions) and schizotypal personality disorder (but they lack the eccentric behavior or magical thinking)

Question 12

What are the criteria for schizotypal personality disorder?

Answer 12

pattern of social deficits marked by eccentric behavior, cognitive or perceptual distortions, and disomfort with close relationships with 5 or more of the following:
1. ideas of reference
2. Odd beliefs or magical thinking inconsistent with cultural beliefs
3. unusual perceptual experiences
4. suspiciousness
5. inappropriate or restricted affect
6 odd or eccentric appearance or behavior
7. few close friends
8. odd thinking or speech
9. excessive social anxiety

Question 13

What are the criteria for antisocial personality disorder?

Answer 13

pattern of disregard for others and violation of the rights of others since age 15 with three or more of the following:

1. failure to conform to social norms by committing unlawful acts
2. deceiftulness/repeated lying/manipulating others for personal gain
3. impulsivity/failure to plan ahead
4. irritability and aggressiveness with repeated fights or assaults
5. recklessness and disregard for safety or self or others
6. irresponsibility/failure to sustain work or honor financial obligations
7. lack of remorse for actions

Question 14

How old do you need to be to get a diagnosis of antisocial personality disorder? What’s it called if your’e younger than this?

Answer 14

18 years old

it’s called conduct disorder if younger

Question 15

What are some risk factors for the development of antisocial personality disorder?

Answer 15

having a first-degree relative with it - fives times more likely
alcoholic parents
hx of physical or sexual abuse

Question 16

What is the best therapy for antisocial personality disorder?

Answer 16

dialectical behavior therapy (but therapy is generally ineffective)

Question 17

What are the symptoms of borderline personality disorder ?(Mnemonic: IMPULSE)

Answer 17

impulsive
moody
paranoid under stress
unstable self image
labile, intense relationships
suicidal
inappropriate anger
vulnerable to abandonment
emptiness

Question 18

True or false: people with borderline personality disorder do not have higher rates of childhood abuse than the general population.

Answer 18

false - higher (but 25-30% report NO such abuse)

Question 19

What are the diagnostic criteria for borderline PD?

Answer 19

pervasive pattern of impulsivity and unstable relationships, affects, self-image and behaviors, present by early adulthood and in a variety of contexts with at least five of the following:

1. desperate efforts to avoid abandonment
2. unstable, intense relationships
3. unstable self-image
4. impulsivity in at least two potentially harmful ways
5. recurrent suicidal threats/attempts or mutilation
6. unstable mood/affect
7. general feeling of emptiness
8. difficulty controlling anger
9. transient, stress-related paranoid ideation or dissociative symptoms

Question 20

What is the suicide rate in borderline PD?

Answer 20

10%

Question 21

What two things should be on the differential diagnosis with borderline PD?

Answer 21

1. schizophrenia (borderline can present with transient psychosis under stress, but won’t have frank psychosis)
2. bipolar II (mood swings can be severe in borderline PD, but will be in reaction to environmental triggers, not characterized by spending excess amounts of money or heightened sexual activity

Question 22

What is splitting in borderline personality?

Answer 22

they view others as all good or all bad

Question 23

What is the treatment for borderline PD?

Answer 23

DBT psychotherapy

pharmacotherapy to treat depressive symptoms as necessary (this has proven more effective in borderline PD than in any other PD)

Question 24

What are the diagnostic criteria for histrionic personality disorder?

Answer 24

pattern of excessive emotionality and attention seeking, present by early adulthood and in a variety of contexts with at least five of the following:

1. uncomfortable when not the center of attention
2. inappropriately seductive or provocative behavior
3. uses physical appearance to draw attention to self
4. has speech that is impressionistic and lacking in detail
5. theatrical and exaggerated expression of emotion
6. easily influenced by others or situation
7. perceives relationships as more intimate than they actually are

Question 25

Which PD is histrionic most often mistaken for?

Answer 25

borderline - but people with histrionic tend to be more functional and less likely to suffer from comorbid depression, psychotic episodes or suicide attempts

Question 26

What are the diagnostic criteria for narcissistic personality disorder?

Answer 26

pattern of grandiosity, need for admiration, lack of empathy beginning by early adulthood and present in a variety of contexts with five or more of the following: 1. exaggerated sense of self-importance 2. preoccupation with fantasies of unlimited money, success, brilliance, etc. 3. believes that he or she is special or unique and can associate only with other high-status individuals 4. needs excessive admiration 5. has a sense of entitlement 6. takes advantage of others for self gain 7. lacks empathy 8. envious of others or believes others are envious of him or her 9. arrogant or haughty

Question 27

What are the diagnostic criteria for avoidant PD?

Answer 27

pattern of social inhibition, hypersensitivity, and feelings of inadequacy since early adulthood with at least 4 of the following: 1. avoids occupation that involves interpersonal contact due to a fear of criticism and rejection 2. unwilling to interact unless certain of being liked 3. cautious of interpersonal relationships 4. preoccupied with being criticized or rejected in social situations 5. inhibited in new social situations because he or she feels inadequate 6. believes he or she is socially inept and inferior 7. reluctant to engage in new activities for fear of embarassment

Question 28

What should be on the differential for avoidant PD?

Answer 28

schizoid PD (but avoidants actually want companionship) social anxiety disorder (but avoidant PD will more pervasive and start earlier in life and more of a fear of rejection as opposed to a fear of embarrassment) dependent PD (because avoidant PD patients tend to cling to relationships, but they're slow to get involved as opposed to dependents who actively and aggressively seek relationships)

Question 29

What is the treatment for avoidant PD?

Answer 29

psychotherapy - particularly assertiveness training | beta blockers to control autonomic symptoms of anxiety, and SSRIs for comorbid major depression

Question 30

What are the diagnostic criteria for dependent personality disorder?

Answer 30

a pattern of submissive and clinging behavior due to excessive need to be taken care of with at least five of the following: 1. difficulty making everyday decisions without reassurance from others 2. needs others to assumed responsibilities for most areas of his or her life 3. cannot express disagreement because of fear of loss of approval 4. difficulty initiating projects because of lack of confidence 5. goes to excessive lengths to obtain support from others 6. feels helpless when alone 7. urgently seeks another relationship when one ends 8. preoccupied with fears of being left to take care of self

Question 31

What defense mechanism often occurs in people with dependent PD?

Answer 31

regression

Question 32

What are the diagnostic criteria for obsessive-compulsive PD?

Answer 32

pattern of preoccupation with orderliness, control and perfectionism at the expense of efficiency, present by early adulthood and in a variety of contexts with at least four of the following: 1. preoccupation with details, rules, list and organization such that the major point of the activity is lost 2. perfectionism that is detrimental to completion of task 3. excessive devotion to work 4. excessive conscientiousness and scrupulousness about morals and ethics 5. will not delegate tasks 6. unable to discard worthless objects 7. miserly 8. rigid and stubbord

Question 33

Which gender is more likely to have OCPD?

Answer 33

men (and happens most often in the oldest child)

Question 34

What is the major difference between OCD and OCPD?

Answer 34

OCPD lack the recurrent obsessions and compulsions OCPD is egosyntonic while OCD is egodystonic