Personality Disorders Flashcards
(62 cards)
1
Q
Patients with personality disorders lack _____ about their problems; their symptoms are ego-(dystonic/syntonic).
They are Axis ____ diagnoses.
A
insight
ego-syntonic
Axis II
2
Q
What is the DSM-IV criteria for a personality disorder?
A
- Pattern of behavior/inner experience that deviates from the person’s culture & is manifested in 2 or more of the following ways:
- Cognition
- Affect
- Personal relations
- Impulse control
- The pattern:
- Is pervasive and inflexible in a broad range of situations
- Is stable and has an onset no later than adolescence or early adulthood
- Leads to significant stress in functioning
- Is not accounted for by another mental/medical illness or by use of a substance
3
Q
Each personality disorder is present in ___% of the population.
Personality disorders are divided into ______.
A
1%
3 clusters
4
Q
Cluster A
A
Schizoid, Schizotypal, Paranoid
- Patients seem eccentric, peculiar or withdrawn
- Familial association w/ psychotic disorders
5
Q
Cluster B
A
Antisocial, Borderline, Histrionic, Narcissistic
- Patients seem emotional, dramatic or inconsistent
- Familial association with mood disorders
6
Q
Cluster C
A
Avoidant, Dependent, Obsessive-compulsive
- Patients seem anxious or fearful
- Familial association w/ anxiety disorders
7
Q
Personality disorder not otherwise specified (NOS)
A
Includes disorders that do not fit into clusters A, B or C (including passive-aggressive personality disorder)
8
Q
What is the etiology of personality disorders?
A
- Biological, genetic, psychosocial factors
- Prevalence in monozygotic twins is several times higher than dizygotic twins
9
Q
How are personality disorders treated?
A
- Difficult to treat
- Few patients aware they need help
- Disorders tend to be chronic, life-long
- Pharmacologic treatment limited usefulness except treating coexisting symptoms of depresison, anxiety, etc.
- Psychotherapy & group therapy most helpful
10
Q
What is the pneumonic for personality disorder clusters?
A
- Cluster A: mad
- Cluster B: bad
- Cluster C: sad
11
Q
What is the DSM-IV criteria for Paranoid Personality Disorder (PPD)?
A
- General distrust of others, beginning in early adulthood & present in a variety of contexts
- At least 4 of the following:
- Suspicion (w/o evidence) that others are exploiting or deceiving him/her
- Preoccupation with doubts of loyalty or trustworthiness of acquaintances
- Reluctance to confide in others
- Interpretation of benign remarks as threatening or demeaning
- Persistence of grudges
- Perception of attacks on his/her character that are not apparent to others; quick to counterattack
- Recurrence of suspicions regarding fidelity of spouse or lover
12
Q
Paranoid Personality Disorder
- Prevalence: ___%
- Men vs Women
- Familial incidence
A
- Prevalence: 0.5 - 2.5%
- Men >> women
- Higher incidence in family members of schizophrenics
13
Q
What is included in the differential diagnosis of PPD?
A
Paranoid schizophrenia
- Unlike patients w/ schizophrenia, patients with PPD do not have any fixed delusions and are not frankly psychotic
- May have transient psychosis under stressful situations
14
Q
What is the course & prognosis of patients w/ PPD?
A
- Some patients may eventually be diagnosed w/ schizophrenia
- Chronic course
- Lifelong marital & job-related problems
15
Q
How is PPD treated?
A
Psychotherapy
Antianxiety medications
Short course of antipsychotics (transient psychosis)
16
Q
What is the DSM-IV criteria for Schizoid Personality Disorder?
A
- A pattern of voluntary social withdrawal & restricted range of emotional expression, beginning in early adulthood & present in a variety of contexts.
- 4 or more of the following must be present:
- Neither enjoying nor desiring close relationships (including family)
- Generally choosing solitary activities
- Little (if any) interest in sexual activity w/ another person
- Taking pleasure in few activities (if any)
- Few close friends or confidants (if any)
- Indifference to praise or criticism
- Emotional coldness, detachment or flattened affect
17
Q
Schizoid Personality Disorder
- Prevalence: ___%
- Men vs. Women
- Familial incidence
A
- Prevalence: 7%
- Men 2x more than women
- No increased incidence in families w/ hx of schizophrenia
18
Q
What is the differential diagnosis for Schizoid Personality Disorder?
A
-
Paranoid schizophrenia
- Unlike pts w/ schizophrenia, patients w/ SPD do not have any fixed delusions, although these may exist transiently in some pts
-
Schizotypal personality disorder
- Pts w/ SPD do not have the same eccentric behavior or magical thinking seen in pts w/ schizotypal personality disorder
19
Q
What is the course and treatment for Schizoid Personality Disorder?
A
- Chronic course, not always lifelong
- Treatment similar to paranoid personality disorder
- Psychotherapy; group therapy
- Low-dose antipsychotics (short course) if transiently psychotic
- Anti-depressants if comorbid major depression is diagnosed
20
Q
What is the DSM-IV criteria for Schizotypal Personality Disorder?
A
- Pattern of social deficits marked by eccentric behavior, cognitive or perceptual distortions & discomfort w/ close relationships, beginning by early adulthood & present in a variety of contexts. 5 or more of the following must be present:
- Ideas of reference (excluding delusions of reference)
- Odd beliefs or maginal thinking, inconsistent w/ cultural norms
- Unusual perceptual experiences (bodily illusions)
- Suspiciousness
- Inappropriate or restricted affect
- Odd of eccentric appearance or behavior
- Few close friends or confidants
- Odd thinking or speech (vague, stereotyped, etc)
- Excessive social anxiety
21
Q
What types of magical thinking & odd behaviors are characteristic of Schizotypal Personality Disorder?
A
-
Magical thinking
- Belief in clairvoyance or telepathy
- Bizarre fantasies or preoccupations
- Belief in superstitions
-
Odd behaviors
- Involvement in cults or strange religious practices
22
Q
Schizotypal Personality Disorder
- Prevalence: ___%
- Familial incidence
A
- Prevalence: 3.0%
- Monozygotic >>> dizygotic twins
23
Q
What is the differential diagnosis for Schizotypal Personality Disorder?
A
-
Paranoid schizophrenia
- Unlike pts w/ schizophrenia, pts w/ schizotypal personality disorder are not frankly psychotic (but can become transiently under stress)
-
Schizoid personality disorder
- Do not have the same eccentric behavior seen in pts w/ schizotypal personality disorder
24
Q
What is the course and treatment for Schizotypal Personality Disorder?
A
- Chronic, pts may develop schizophrenia
- Psychotherapy is treatment of choice
- Short course of low-dose antipsychotics if necessary (transient psychosis)
25
What is the DSM-IV criteria for Antisocial Personality Disorder?
* Pattern of disregard for others & violation of the rights of others since age 15.
* Patients must be at least **18 years old**
* Hx of behavior as child/adolescent must be consistent w/ **conduct disorder**
* 3 or more of the following should be present:
* Failure to conform to social norms by committing unlawful acts
* Deceitfulness/repeated lying/manipulating others for personal gain
* Impulsivity/failure to plan ahead
* Irritability & aggressiveness/repeated fights or assaults
* Recklessness & disregard for safety of self or others
* Irresponsibility/failure to sustain work or honor financial obligations
* Lack of remorse for actions
26
**Antisocial Personality Disorder**
* Prevalence: \_\_\_%
* What SES has higher incidence?
* Genetic component
* Prevalence
* Men 3%, Women 1%
* Poor urban areas & prisoners
* 5x increased risk among 1st degree relatives
27
What is the differential diagnosis of Antisocial Personality Disorder?
**Drug abuse**
* Necessary to ascertain which came first
* Pts who began abusing drugs before their antisocial behavior may have behavior attributable to the effects of their addiction
28
What is the course & treatment of Antisocial Personality Disorder?
* Chronic course
* Some improvement of symptoms as the pt ages
* Many pts have **somatic complaints**
* Co-existence of **substance abuse** and/or major **depression** is common
* Treatment
* Psychotherapy
* Pharmacotherapy for anxiety/depression (caution: highly addictive)
29
What is the acronym for Borderline Personality Disorder?
**IMPULSIVE**
* **I**mpulsive
* **M**oody
* **P**aranoid under stress
* **U**nstable self image
* **L**abile, intense relationships
* **S**uicidal
* **I**nappropriate anger
* **V**ulnerable to abandonment
* **E**mptiness
30
What is the DSM-IV criteria for Borderline Personality Disorder?
* Pervasive pattern of **impulsivity** & **unstable** relationships, affects, self-image, and behaviors, present by early adulthood & in a variety of contexts
* At least 5 of the following must be present:
* Desperate efforts to avoid real or imagined abandonment
* Unstable, intense interpersonal relationships
* Unstable self-image
* Impulsivity in at least 2 potentially harmful ways (spending, sexual activity, substance use, etc.)
* Recurrent suicidal threats or attempts or self-mutilation
* Unstable mood/affect
* General feeling of emptiness
* Difficulty controlling anger
* Transient, stress-related paranoid ideation or dissociative symptoms
31
**Borderline Personality Disorder**
* Prevalence: \_\_\_%
* Women vs. Men
* Suicide rate: \_\_\_%
* Prevalence: 1-2%
* Women 2x more than men
* Suicide rate: 10%
32
What is the differential diagnosis for Borderline Personality Disorder?
**Schizophrenia**
* Unlike pts with schizophrenia, pts w/ borderline personality disorder do not have frank psychosis
* May have transient psychosis, however, if decompensate under stress
33
What is the course of Borderline Personality Disorder?
* Stable, chronic course
* High incidence of coexisting major depression and/or substance abuse
* Increased risk of suicide
* Patients will make suicide gestures and kill themselves by accident
34
How is Borderline Personality Disorder treated?
* **Psychotherapy** is the treatment of choice
* Behavior therapy
* Cognitive therapy
* Social skills training
* **Pharmacotherapy**
* Psychotic or depressive symptoms
35
What is the DSM-IV criteria for Histrionic Personality Disorder?
* Pattern of excessive **emotionality** & **attention** **seeking**, present by early adulthood and in a variety of contexts
* At least 5 of the following must be present:
* Uncomfortable when not the center of attention
* Inappropriately seductive or provocative behavior
* Uses physical appearance to draw attention to self
* Has speech that is impressionistic and lacking in detail
* Theatrical & exaggerated expression of emotion
* Easily influenced by others or situation
* Perceives relationships as more intimate than they actually are
36
Pharmacotherapy has been shown to be more useful in __________ disorder than in any other personality disorder.
Borderline personality disorder
37
**Histrionic Personality Disorder**
* Prevalence: \_\_\_%
* Women vs. Men
* Prevalence: 2-3%
* Women \>\> Men
38
What is the differential diagnosis for Histrionic Personality Disorder?
**Borderline Personality Disorder**
* Patients w/ BPD are more likely to suffer from depression & to attempt suicide
* HPD pts are generally more functional
39
What is the course & treatment for Histrionic Personality Disorder?
* Chronic course, some improvement of symptoms with age
* Psychotherapy is the treatment of choice
* Pharmacotherapy to treat associated depressive or anxious symptoms
40
Histrionic patients often use the defense mechanism of \_\_\_\_\_\_.
Regression (revert to childlike behaviors)
41
What is the DSM-IV criteria for Narcissistic Personality Disorder (NPD)?
* Pattern of grandiosity, need for admiration, & lack of empathy beginning by early adulthood and present in a variety of contexts.
* 5 or more of the following must be present:
* Exaggerated sense of self-importance
* Preoccupied w/ fantasies of unlimited money, success, brilliance, etc.
* Believes that he/she is "special" or unique and can associate only with other high-status individuals
* Needs excessive admiration
* Has sense of entitlement
* Takes advantage of others for self-gain
* Lacks empathy
* Envious of others or believes others are envious of him/her
* Arrogant or haughty
42
What is the prevalence of Narcissistic Personality Disorder?
\<1%
43
What is the differential diagnosis for Narcissistic Personality Disorder?
**Antisocial personality disorder**
* Both types of pts exploit others
* But, NPD pts want status & recognition, while antisocial pts want material gain or simply the subjugation of others
* Narcissistic pts become depressed when they don't get the recognition they think they deserve
44
What is the course & treatment for Narcissistic Personality Disorder?
* Chronic course
* Higher incidence of depression & midlife crisis
* *High value on youth & power*
* **Psychotherapy** is treatment of choice
* Antidepressants or lithium if needed
* For mood swings if comorbid mood disorder is diagnosed
45
Patients with avoidant personality disorder _____ companionship but are extremely _____ and easily \_\_\_\_\_.
desire, shy, injured
46
What is the DSM-IV criteria for avoidant personality disorder?
A pattern of social inhibition, hypersensitivity & feelings of inadequacy since early adulthood, w/ at least 4 of the following:
* Avoids occupation that involves interpersonal contact due to a fear of criticism and rejection
* Unwilling to interact unless certain of being liked
* Cautious of intrapersonal relationships
* Preoccupied w/ being criticized or rejection in social situations
* Inhibited in new social situations b/c he/she feels inadequate
* Believes he or she is socially inept and inferior
* Reluctant to engage in new activities for fear of embarrassment
47
**Avoidant Personality Disorder**
* Prevalence: \_\_\_%
* Men vs. Women
* Prevalence: 1-10%
* Sex ratio unknown
48
What is the differential diagnosis for Avoidant Personality Disorder?
* **Schizoid personality disorder**
* Pts w/ APD desire companionship but are extremely shy
* Pts w/ schizoid have no desire for companionship
* **Social phobia**
* Fear & avoidance of social situations
* Personality disorder if integral part of personality and evident before adulthood
* Social phobia: fear of embarrassment in setting
* APD: fear of rejection & sense of inadequacy
* **Dependent personality disorder**
* APD pts cling to relationships but slow to get involved; dependents more aggressive
49
What is the course of Avoidant Personality Disorder?
* Course usually chronic
* Difficult during adolescence, when attractiveness & socialization are important
* Increased incidence of associated anxiety & depressive disorders
50
How is Avoidant Personality Disorder treated?
* **Psychotherapy**
* Assertiveness therapy most effective
* **Beta blockers**
* Control autonomic symptoms of anxiety
* **SSRIs**
* Major depression
51
What is the DSM-IV criteria for Dependent Personality Disorder?
A pattern of submissive & clinging behavior due to excessive need to be taken care of. At least 5 of the following must be present:
* Difficulty making everyday decisions w/o reassurance from others
* Needs others to assume responsibilities for most areas of his/her life
* Cannot express disagreement b/c of fear of loss of approval
* Difficulty initiating projects b/c of lack of self-confidence
* Goes to excessive lengths to obtain support from others
* Feels helpless when alone
* Urgently seeks another relationship when one ends
* Preoccupied w/ fears of being left to take care of self
52
**Dependent Personality Disorder**
* Prevalence: \_\_\_%
* Women vs. Men
* Prevalence: 1%
* Women \>\>\> Men
53
What is the differential diagnosis for Dependent Personality Disorder?
* Avoidant personality disorder
* **Borderline & histrionic personality disorder**
* DPD: long-lasting relationship w/ one person on whom they are dependent
* Borderline/Histrionic: dependent on other people but unable to maintain a long-lasting relationship
54
What is the course of Dependent Personality Disorder?
* Usually chronic course
* Symptoms decrease w/ age and/or therapy
* Pts prone to depression, particularly after loss of person on whom they are dependent
55
How is Dependent Personality Disorder treated?
* Psychotherapy is the treatment of choice
* Pharmacotherapy
* Treat associated symptoms of anxiety or depression
56
What is the DSM-IV criteria for Obsessive-Compulsive Personality Disorder (OCPD)?
Pattern of preoccupation w/ orderliness, control & perfectionism at the expense of efficiency, present by early adulthood & in a variety of contexts. At least 4 of the following must be present:
* Preoccupation w/ details, rules, lists and organization such that the major point of the activity is lost
* Perfectionism that is detrimental to completion of task
* Excessive devotion to work
* Excessive consientiousness & scrupulousness about morals & ethics
* Will not delegate tasks
* Unable to discard worthless objects
* Miserly
* Rigit & stubborn
57
**Obsessive Compulsive Personality Disorder**
* Prevalence: \_\_\_%
* Men vs. Women
* Family incidence
* Prevalence unknown
* Men \>\> women
* Most often in the oldest child
* Increased incidence in 1st degree relatives
58
What is the differential diagnosis for OCPD?
* **OCD**
* Pts w/ OCPD don't have recurrent obsessions or compulsions in OCD
* Symptoms of OCPD are _ego-syntonic_ rather than ego-dystonic
* **Narcissistic personality disorder**
* Both personalities involve assertiveness & achievement
* NPD pts motivated by status, OCD pts motivated by the work itself
59
What is the course for pts with OCPD?
* Unpredictable course
* Some pts later develop obsessions or compulsions (OCD), some develop schizophrenia or MDD, others may improve or remain stable
60
How is OCPD treated?
* Psychotherapy is treatment of choice
* Group therapy & behavior therapy may be useful
* Pharmacotherapy may be used to treat associated symptoms as necessary
61
What does Personality Disorder Not Otherwise Specified (NOS) include?
* Passive-aggressive personality disorder
* Depressive personality disorder
* Sadomasochistic personality disorder
* Sadistic personality disorder
62
Describe pts with Passive-Aggressive Personality Disorder
How is it treated?
* Stubborn, inefficient procrastinators
* Alternate btwn compliance & defiance
* Passively resist fulfillment of tasks
* Frequently make excuses for themselves & lack assertiveness
* Attempt to manipulate others to do their chores, errands, etc.
* Frequently complain about their own misfortunes
* Treatment: psychotherapy
